Pancreatic cancer in the general population: Improvements in survival over the last decade
Taylor S. Riall, Jean L. Freeman, Courtney M. Townsend, James S. Goodwin, Yong-fang Kuo, Zhang Dong, William H. Nealon; Surgery, University of Texas Medical Branch , Galveston , TX
Background: Pancreatic cancer (PCa) is the 4th leading cause of cancer deaths in men and women in the US . High-volume pancreatic surgery centers (>50 cases/yr) have shown improvements in survival following surgical resection over the last 3 decades. It is unknown whether this improvement has been translated to all patients with PCa, many of whom are not treated at high-volume centers. Objective: The goal of this study was to examine population-based data in patients with PCa to evaluate trends in surgical resection and survival over the last decade. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, all patients diagnosed with PCa from 1988-1999 were identified. The database was divided into 3 equal time intervals from 1988-1991, 1992-1995, and 1996-1999. The survival and proportion of patients undergoing surgical resection were compared for each time period. Results: There were 24,016 patients with PCa identified. Of the 19,533 patients with stage data available, 7.3% had localized disease, 23.9% had regional disease, and 50.1% had distant disease. For all patients with localized PCa there was no difference in 2-yr survival when comparing the 3 time periods. The percentage of patients resected increased from 18.8% to 20.2% to 25.5% over the 3 time periods (p=0.003). For those with localized disease undergoing surgical resection, 2-year survival ranged from 43.0% to 46.5% over the three time periods (p=0.93). Patients with regional PCa showed an improvement in survival from 9.5% to 13.5% over the three time periods (p<0.0001). Significantly, the rate of surgical resection increased from 23.0% to 28.6% to 32.5% (p<0.0001) in those with regional disease. Following surgical resection for regional PCa, 2-yr survival increased from 21.5% to 28.9% (p=0.002) over the three time periods. In a Cox model of all patients with resected local/regional PCa, the year of diagnosis was significant with a 3% improvement in survival per year studied (CI=2.5% - 4.5%, p=0.0001) after adjusting for other prognostic factors. For all patients with distant disease, the 2-yr survival increased from 1.4% in 1988-1991 to 2.3% in 1996-1999 (p<0.0001). Conclusions: Patients with PCa in the general population are shown to have improved survival over the past decade in both unadjusted and adjusted models. This improvement is most striking for patients with local/regional disease and is consistent with trends seen at high-volume centers The improved survival likely reflects increased resection rates and improvements in resection techniques over time. Improvements seen for distant disease may be explained by advances in chemotherapeutic regimens.
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