Objectives: Over the last decade, there have been significant improvements in the diagnosis and treatment of pancreatic cancer. In 2011, the standard of care for timing of delivery and regimen of systemic therapy shifted towards that of neoadjuvant multiagent chemotherapy. However, the implication for survival of pancreatic cancer patients at a population level remains unclear.
Methods: A retrospective study of the National Cancer Database from 2004-2019 was conducted. Patients were deemed “Era 1” if they were diagnosed between 2004-2010, or “Era 2” if diagnosed between 2011-2019. Data analyses were conducted in R.
Results: A total of 316393 patients with pancreatic adenocarcinoma were identified, with 87742 treated during Era 1, and 228651 treated during Era 2. On multivariate analysis, particular socioeconomic factors were significantly associated with increased survival, including private insurance, higher income, and receipt of treatment in the Northeast, and at an academic center. These trends persisted across subset analyses. Across all subset analyses, rates of MA chemotherapy administration significantly increased between Era 1 and Era 2. On multivariate analysis, survival consistently increased in the full cohort (Figure 1) and across subset analyses, including surgical patients (HR 0.85, 95% CI 0.82-0.88, p< 0.001), imminently resectable patients (HR 0.90, 95% CI 0.86-0.95, p< 0.001), high risk patients (HR 0.82, 95% CI 0.79-0.85), p< 0.001), and stage IV patients (HR 0.86, 95% CI 0.84-0.89, p< 0.001). Regardless of year of treatment, rates of surgery in imminently resectable patients were about 50%. However, in imminently resectable patients who underwent surgical resection of disease, median survival increased from 22.7 to 26.6 months from Era 1 to Era 2 (HR 0.92, 95% CI 0.87-0.97, p=0.001). A similar increase in median survival was observed in high risk surgical patients, rising from 18.0 to 22.8 months from Era 1 to Era 2 (HR 0.81, 95% CI 0.77-0.85, p< 0.001).
Conclusion: The advent of MA chemotherapy has improved outcomes in all patients. Unfortunately, the underuse of surgery in imminently resectable patients persists. Across all subset analyses, outcome disparities are observed with respect to insurance status, location, and facility type.
