Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2025
Patterns of treatment and survival in borderline resectable and locally advanced pancreatic cancer.
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Franklin Oskar, Stoop Thomas F, Rodriguez Franco Salvador, Sugawara Toshitaka, Ishida Hiroyuki, Halimi Asif, Colborn Kathryn, Gleisner Ana, Schulick Richard D, Del Chiaro Marco
Аннотация
BACKGROUND: Treatment options for pancreatic cancer with major arterial involvement has evolved in the last decades with the introduction of multi-agent chemotherapies. This study aimed to explore treatment patterns of surgical and oncological treatment for clinical stage T4 pancreatic cancer in the United States.
METHODS: The study included clinical T4M0 pancreatic cancer cases treated between 2004 and 2021 in the US National Cancer Database. Treatment patterns and overall survival were evaluated and divided into three time periods (2004-2010, 2011-2016, 2017-2021). Odds of resection were assessed with multivariable logistic regression.
RESULTS: In total, 47,345 cases were analyzed, of which 4222 (8.9 %) underwent surgery. The median age was 68 years, 49 % were male and 77.0 % reported non-hispanic white race. The proportion of patients that received no treatment decreased from 31.2 % to 23.6 % and the proportion that received both chemotherapy and surgery increased from 4.4 % to 11.1 %. Among patients that received upfront chemotherapy (n = 28,445), single-agent chemotherapy dominated in 2004 but was almost completely replaced by multi-agent chemotherapy by 2021. Median overall survival improved; for non-resected patients from 10.8 months in 2004-2010 to 14.9 months in 2017-2021 (p < .001), and for resected patients from 25.2 to 32.7 months (p < .001). Variables associated with higher odds of resection included private insurance and center volume, whereas age, race/ethnicity, clinical N1-2 and a body/tail tumor location was associated with lower odds.
CONCLUSIONS: Treatment for pancreatic cancer with major arterial involvement has shifted towards an increased use of multi-agent chemotherapy and surgical resection, with an associated improved overall survival.
METHODS: The study included clinical T4M0 pancreatic cancer cases treated between 2004 and 2021 in the US National Cancer Database. Treatment patterns and overall survival were evaluated and divided into three time periods (2004-2010, 2011-2016, 2017-2021). Odds of resection were assessed with multivariable logistic regression.
RESULTS: In total, 47,345 cases were analyzed, of which 4222 (8.9 %) underwent surgery. The median age was 68 years, 49 % were male and 77.0 % reported non-hispanic white race. The proportion of patients that received no treatment decreased from 31.2 % to 23.6 % and the proportion that received both chemotherapy and surgery increased from 4.4 % to 11.1 %. Among patients that received upfront chemotherapy (n = 28,445), single-agent chemotherapy dominated in 2004 but was almost completely replaced by multi-agent chemotherapy by 2021. Median overall survival improved; for non-resected patients from 10.8 months in 2004-2010 to 14.9 months in 2017-2021 (p < .001), and for resected patients from 25.2 to 32.7 months (p < .001). Variables associated with higher odds of resection included private insurance and center volume, whereas age, race/ethnicity, clinical N1-2 and a body/tail tumor location was associated with lower odds.
CONCLUSIONS: Treatment for pancreatic cancer with major arterial involvement has shifted towards an increased use of multi-agent chemotherapy and surgical resection, with an associated improved overall survival.