Are Body/Tail Pancreatic Cancers Really Worse Per Se? Debunking a Myth
Elizaveta Ragulin-Coyne*1, Elan R. Witkowski1, Jillian K. Smith1, Joshua S. Hill3, James T. Mcphee4, Sing Chau NG1, Waddah B. Al-Refaie2, Shimul a. Shah1, Jennifer F. Tseng1
1Surgical Outcomes Analysis & Research (SOAR) Department of Surgery, University of Massachusetts Medical School, Worcester, MA; 2Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN; 3Department of Surgical Oncology, Division of Surgery, University of Texas MD Anderson Center, Houston, TX; 4Division of Vascular Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA
BACKGROUND:Pancreatic cancers of the body and tail have been described to have poorer survival compared with that of the head. In order to eliminate the possible confounding of later stage at diagnosis for body/tail lesions, we examined the impact of cancer location on overall survival in a cohort of early stage pancreatic adenocarcinoma patients. METHODS: SEER-Medicare 1991-2005 was used to identify patients with localized, node negative (Stage 1) pancreatic adenocarcinoma as defined by SEER historic stage and abstracted histological data. Chi square analyses were performed to define and describe the head and body/tail cohorts. Kaplan-Meier survival analysis was performed comparing head vs. body/tail groups in resected, unresected and overall cohorts. Finally, Cox proportional hazards modeling was used to control for the effects of age, sex, race, resection, chemotherapy, and radiation on head and body/tail groups.RESULTS:1320 patients with localized, node-negative pancreatic adenocarcinoma were identified; 309 of them underwent resection. In all, 1098 head and 222 body/tail cancers were identified. Within resected group, median survival from diagnosis were similar for head and body/tail lesions (18 mo for head vs. 18.5 mo for body/tail, p=0.66). Within unresected group, head patients demonstrated a trend toward longer survival (6.3 mo vs. 5.0 mo, p=0.07). For all patients (resected and unresected), the survival was equivalent (head, 7.5 mo vs. body/tail 7.2 mo, p=0.64). Cox analysis was used to assess independent factors impacting survival. In the total cohort, age> 85 was a negative predictive factor HR 1.22 p=0.03; chemotherapy (HR 0.58 p<0.01) and resection (HR 0.32 p<0.01) were positive predictive factors. After adjustment, body/tail lesions did not demonstrate a significantly different risk of death compared to head lesions (HR 1.1 p=0.24).CONCLUSION:Using a large national database, we have demonstrated that localized, node-negative pancreatic cancers in the body and tail of the pancreas have equivalent survival compared to head lesions, after adjustment of patient and treatment factors. Patients with resectable tumors of the body and tail deserve prompt and comparable surgical evaluation.
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