{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:16:46Z","timestamp":1791919006900,"version":"4.3.4"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,4]],"date-time":"2020-12-04T00:00:00Z","timestamp":1607040000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012155","name":"National Institute for Medical Research Development","doi-asserted-by":"publisher","award":["963236"],"award-info":[{"award-number":["963236"]}],"id":[{"id":"10.13039\/501100012155","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100013743","name":"World Cancer Research Fund International","doi-asserted-by":"crossref","award":["WCRF 2016\/1633"],"award-info":[{"award-number":["WCRF 2016\/1633"]}],"id":[{"id":"10.13039\/100013743","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>Investigating the survival features, and determinants of treatment and stage at presentation in Iran<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>461 patients with pancreatic ductal adenocarcinoma (PC) were prospectively enrolled from Shariati hospital, Tehran, Iran, between 2011\u20132018. All patients underwent endoscopic ultrasonography, computed tomography scanning, and physical examination. Validated questionnaire was completed for the participants and all were actively followed on monthly basis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Median survival time was 6.5 months, and 1-, and 5-year survival rates were 26.2%, and 1.5%. Patients who were older (p&lt;0.001), illiterate (p = 0.004), unmarried (p = 0.003), rural inhabitant (p = 0.013), opium user (p = 0.039), and had lower body mass index (BMI) (p = 0.002) had lower overall survival. Tumors located in the head of pancreas were more commonly diagnosed at lower stages (p&lt;0.001). Only 10.4% of patients underwent surgery who were more commonly educated (p&lt;0.001), married (p = 0.005), had a tumor located in the head of pancreas (p = 0.016), and were diagnosed at lower stages (p&lt;0.001). After adjustment for potential confounders and risk factors, rural inhabitance (HR: 1.33 (95% CI: 1.01\u20131.74)), having more symptoms (HR for each increasing symptom: 1.06 (1.02\u20131.11)), using opium (HR: 1.51 (1.04\u20132.20)), having a tumor located in the body of pancreas (HR: 1.33 (1.02\u20131.75)), and having an advanced tumor stage (HR: 2.07 (1.34\u20133.19)) remained significantly associated with increased risk of mortality. After the adjusting for potential confounders, we did not find significant relationships between smoking, alcohol intake, and BMI with the risk of death among patients with pancreatic cancer.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Iranian patients with PC have very poor long-term survival. Besides tumor\u2019s stage and location, socioeconomic disparities could affect the probabilities of receiving treatment and\/or survival in these patients. Opium use is an independent risk factor for mortality among PC patients in Iran.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0243511","type":"journal-article","created":{"date-parts":[[2020,12,4]],"date-time":"2020-12-04T19:55:26Z","timestamp":1607111726000},"page":"e0243511","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Survival features, prognostic factors, and determinants of diagnosis and treatment among Iranian patients with pancreatic cancer, a prospective study"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3972-7824","authenticated-orcid":true,"given":"Mahdi","family":"Sheikh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar","family":"Masoudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Razieh","family":"Bakhshandeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Moayyedkazemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhad","family":"Zamani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sepideh","family":"Nikfam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masoumeh","family":"Mansouri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neda Ghamarzad","family":"Shishavan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saman","family":"Nikeghbalian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Brennan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9820-6335","authenticated-orcid":true,"given":"Reza","family":"Malekzadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akram","family":"Pourshams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,4]]},"reference":[{"key":"pone.0243511.ref001","first-page":"394","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"F Bray","year":"2018","journal-title":"CA: A Cancer Journal for Clinicians"},{"key":"pone.0243511.ref002","first-page":"7","article-title":"Global temporal patterns of pancreatic cancer and association with socioeconomic development","author":"MCS Wong","year":"2017","journal-title":"Sci Rep"},{"key":"pone.0243511.ref003","first-page":"934","article-title":"The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017. 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A Population-Based Study in The Netherlands","author":"MHG van Roest","year":"2016","journal-title":"PLoS One"},{"key":"pone.0243511.ref007","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1097\/MPA.0000000000001133","article-title":"Long-Term Survivors of Pancreatic Cancer","volume":"47","author":"A Kardosh","year":"2018","journal-title":"Pancreas"},{"key":"pone.0243511.ref008","doi-asserted-by":"crossref","first-page":"4846","DOI":"10.3748\/wjg.v24.i43.4846","article-title":"Pancreatic cancer: A review of clinical diagnosis, epidemiology, treatment and outcomes","volume":"24","author":"A McGuigan","year":"2018","journal-title":"World J Gastroenterol"},{"key":"pone.0243511.ref009","doi-asserted-by":"crossref","first-page":"4981","DOI":"10.2147\/CMAR.S173666","article-title":"Improving risk prediction for pancreatic cancer in symptomatic patients: a Saudi Arabian study","volume":"10","author":"AE Ahmed","year":"2018","journal-title":"Cancer Manag Res"},{"key":"pone.0243511.ref010","article-title":"Pancreatic Cancer in Iran: an Epidemiological Review","author":"FH Siri","year":"2019","journal-title":"J Gastrointest Canc"},{"key":"pone.0243511.ref011","doi-asserted-by":"crossref","first-page":"e3922","DOI":"10.1097\/MD.0000000000003922","article-title":"Opium use, cigarette smoking, and alcohol consumption in relation to pancreatic cancer","volume":"95","author":"R Shakeri","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"pone.0243511.ref012","doi-asserted-by":"crossref","first-page":"e649","DOI":"10.1016\/S2214-109X(20)30059-0","article-title":"Opium use and subsequent incidence of cancer: results from the Golestan Cohort Study","volume":"8","author":"M Sheikh","year":"2020","journal-title":"The Lancet Global Health"},{"key":"pone.0243511.ref013","article-title":"Carcinogenicity of opium consumption","author":"S Warnakulasuriya","year":"2020","journal-title":"The Lancet Oncology"},{"key":"pone.0243511.ref014","first-page":"102","article-title":"Validity and reliability of a questionnaire designed to assess risk factors of pancreatic cancer in Iran","volume":"17","author":"S Farrokhzad","year":"2014","journal-title":"Arch Iran Med"},{"key":"pone.0243511.ref015","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/978-1-4757-3656-4","volume-title":"AJCC Cancer Staging Manual","author":"FL Greene","year":"2002"},{"key":"pone.0243511.ref016","unstructured":"European Cancer Information System. 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Available: https:\/\/www.cancer.org\/cancer\/pancreatic-cancer\/detection-diagnosis-staging\/survival-rates.html"},{"key":"pone.0243511.ref019","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/S0140-6736(17)33326-3","article-title":"Global surveillance of trends in cancer survival 2000\u201314 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries","volume":"391","author":"C Allemani","year":"2018","journal-title":"The Lancet"},{"key":"pone.0243511.ref020","first-page":"13","article-title":"Urban versus rural residency and pancreatic cancer survival: A Danish nationwide population-based cohort study","author":"J Kirkeg\u00e5rd","year":"2018","journal-title":"PLoS One"},{"key":"pone.0243511.ref021","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1200\/jco.2015.33.3_suppl.260","article-title":"Exploration of rural disparities in pancreatic cancer staging and 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Medicine"},{"key":"pone.0243511.ref028","first-page":"4","article-title":"A case\u2013control study comparing the incidence of early symptoms in pancreatic and biliary tract cancer","author":"MG Keane","year":"2014","journal-title":"BMJ Open"},{"key":"pone.0243511.ref029","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1097\/MPA.0000000000000527","article-title":"Symptoms of Pancreatic Cancer in Primary Care: A Systematic Review","volume":"45","author":"M Schmidt-Hansen","year":"2016","journal-title":"Pancreas"},{"key":"pone.0243511.ref030","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1038\/bjc.2012.190","article-title":"The risk of pancreatic cancer in symptomatic patients in primary care: a large case-control study using electronic records","volume":"106","author":"S Stapley","year":"2012","journal-title":"Br J Cancer"},{"key":"pone.0243511.ref031","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/S1091-255X(00)80105-5","article-title":"Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators","volume":"4","author":"TA Sohn","year":"2000","journal-title":"J Gastrointest Surg"},{"key":"pone.0243511.ref032","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1080\/13651820802291233","article-title":"The anatomic location of pancreatic cancer is a prognostic factor for survival","volume":"10","author":"A Artinyan","year":"2008","journal-title":"HPB (Oxford)"},{"key":"pone.0243511.ref033","doi-asserted-by":"crossref","first-page":"10802","DOI":"10.3748\/wjg.v20.i31.10802","article-title":"Prognostic factors related with survival in patients with pancreatic adenocarcinoma","volume":"20","author":"A Bilici","year":"2014","journal-title":"World J Gastroenterol"},{"key":"pone.0243511.ref034","first-page":"54","article-title":"Chemotherapy in Pancreatic Cancer: A Systematic Review","author":"L Hajatdoost","year":"2018","journal-title":"Medicina 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