A. Salami1, A. Joshi1 1Albert Einstein Medical Center,Surgery,Philadelphia, PA, USA
Introduction: Pancreatic cancer remains the 4th leading cause of cancer deaths in the United States. Despite improvements in overall survival for most cancers, survival for patients with pancreatic cancer has remained persistently low. We sought to compare recent trends in clinical presentation, treatment, and survival for pancreatic adenocarcinoma.
Methods: A retrospective cohort study using data from the SEER program (2014 – 2014). All patients with a histologic diagnosis of pancreatic adenocarcinoma were included. The exposure of interest was the era of diagnosis, 2004 – 2009 (Era-A) vs. 2010 – 2014 (Era-B). Outcomes of interest were the: (1) incidence of metastatic disease (2) utilization of resection and (3) overall survival. Multivariable logistic and Cox regression analyses were performed to elucidate associations.
Results: A total of 62,201 patients were included in this study [Era-B – 31,998 (51.4%)]. A significant higher proportion of patients diagnosed in Era-B were older (68.8 vs. 68.1 years), non-Caucasian (20.2 vs. 19.6%) and insured (95.3 vs. 51.4%); p<0.05 for all. No significant gender differences were observed between the study groups. On univariate analysis, patients diagnosed in Era-B were less likely to present with metastatic disease (OR: 0.95, CI: 0.92-0.98, p=0.002), undergo resection (OR: 0.87, CI: 0.83-0.92; p<0.001) or suffer mortality (HR: 0.91, CI: 0.90-0.93; p<0.001). Following multivariable adjustment, having a diagnosis of pancreatic cancer in Era-B was independently associated with a decreased incidence of metastatic disease (OR: 0.91, CI: 0.88-0.96; p<0.001), and mortality (HR: 0.88, CI: 0.86-0.89; p<0.001). Similarly, for patients with non-metastatic disease, having a diagnosis in Era-B was an independent predictor of resection (OR: 1.11, CI: 1.04-1.20; p=0.002). The association between era of diagnosis and mortality was independent of resection status (resected patients – HR: 0.80, CI: 0.76-0.85; p<0.001 and unresected patients – HR: 0.89, CI: 0.87-0.91; p<0.001).
Conclusion: There has been significant improvement in pancreatic cancer care over the last decade, as evidenced by earlier diagnosis, increased utilization of surgery, and improvement in overall survival for both resected and unresected patients. Patients with pancreatic cancer should be encouraged to undergo evidence-based and guideline-driven treatment, in order to optimize outcomes.