Clinical Profile and Outcome of Pancreatic Head Malignancies Among Patients at a Tertiary Referral Hospital – A Seven-year Retrospective Review

Abstract

Background: Malignancies of the head of the pancreas pose a significant global challenge due to their late presentation and the disease's aggressive nature. Modifiable risk factors, such as obesity, cigarette smoking, and alcohol consumption, are expected to increase, leading to a higher incidence of pancreatic cancer. Although the incidence of pancreatic cancer in Africa is expected to increase, data on pancreatic head malignancies in the region are abysmal. This study aimed to assess the current status of pancreatic cancer diagnosis and treatment options in Northern Tanzania.

Methods: We conducted a retrospective hospital-based study from January 2016 to December 2023 at a tertiary hospital in northern Tanzania. We aimed to investigate clinical presentation, management outcomes, and survival analysis. We retrieved data on patients diagnosed with pancreatic head tumours from the cancer registry. Data on demographics, clinical features, diagnostics, treatment, and outcomes were extracted from the cancer registry and hospital records. Descriptive statistics are presented as means with standard deviations (SD) or medians with interquartile ranges (IQR) for continuous variables, and frequencies with percentages for categorical variables. The chi-square (χ²) test assessed the association between categorical variables, while the grouped sample t-test or one-way ANOVA evaluated continuous outcomes at a 95% confidence interval. Significance was set at P < 0.05. Survival was analysed using the Kaplan–Meier method and log-rank tests, with Cox regression used to identify independent predictors of mortality. Ethical approval was obtained from the institutional review board, with consent waived due to the study’s retrospective nature.

Results: A total of 132 patients were included in this study, with a mean age of 61 years and a slight male predominance of 56.1%. Despite the low rate of chemotherapy administration (15.9%), treatment was associated with improved 30-day overall survival (OS 77.7% for recipients vs. 60.4% for non-recipients). Chronic pancreatitis was significantly associated with increased mortality (HR 5.92, p=0.019).

Conclusion: Our study reveals a high rate of late-stage presentations, limited diagnostic and treatment options, and markedly poor survival outcomes for patients with tumours of the head of the pancreas in northern Tanzania. The findings underscore the necessity for enhanced diagnostic and treatment strategies for pancreaticobiliary malignancies, given the significant mortality risks linked to certain factors and the limited use of invasive treatments. Further research is essential to develop more cost-effective interventions and enhance patient outcomes.