Factors Associated with Treatment and Survival of Early Stage Pancreatic Cancer in the Era of Modern Chemotherapy: An Analysis of the National Cancer Database

Watson, Michael; Miller-Ocuin, Jennifer L.; Driedger, Michael; Beckman, Michael J.; McKillop, Iain H.; Baker, E.; Martinie, John B.; Vrochides, Dionisios; Iannitti, David A.; Ocuin, Lee M.

doi:10.1089/pancan.2020.0011

Cited by 16 publications

(25 citation statements)

References 30 publications

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“…The best preventive strategy for this condition has been affirmed to entail risk reduction via lifestyle modification [23][24][25]. Lifestyle modification includes regular exercise, a diet high in fruits and vegetables, a healthy weight, and smoking cessation [26]. In addition, this study also recognizes a possible genetic component in the incidence and mortality of pancreatic cancer evident by higher incidence rates in the Black population as well as higher incidence in male residents compared to female residents.…”

Section: Discussionmentioning

confidence: 99%

Geographical Distribution of Pancreatic Cancer in the State of Mississippi by Incidence and Mortality From 2003 to 2019

Nduma¹,

Ambe²,

Ekhator³

et al. 2022

Cureus

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Background: Pancreatic cancer can be a very debilitating disease. In the USA and around the world, pancreatic cancer is among the causes of cancer-related deaths. This study aims to highlight mortality and incidence rates of pancreatic cancer by geographic location.Methods: The study area is the state of Mississippi with a targeted time period between 2003 and 2019. The Mississippi Cancer Registry is the source of data for this study. The subject under investigation was divided into two phases. The first phase involved analyzing data on the incidence rate while the second phase entailed data analysis of the pancreatic cancer mortality rate in Mississippi. In both phases, the focus was on three categories of geographic locations in Mississippi, which include public health districts, the regional cancer coalitions in the state, and the interplay between rural and urban locations. Descriptive and inferential statistical approaches with graphical techniques and tabulations were utilized in data presentation.Results: The results of this study demonstrate there are variations in the incidence rates of pancreatic cancer by geographic location in Mississippi. In the data analysis of the Mississippi public health districts, the worst-hit areas include the rural communities in the rural-urban regional analysis, the Delta region among the cancer coalition regions, and the Central District (incidence rates) and North District (mortality rates). Conclusion:In Mississippi, there is a need for aggressive community-based participation and education. This approach will help improve screening and early detection of pancreatic cancer. Healthcare intake should be boosted and geared toward a reduction in mortality rates. To minimize disparities that eventually lead to differences in disease incidence and mortality from different locations, legislative and nonlegislative authorities should advocate for equitable distribution of healthcare resources. An understanding of the geographic distribution of pancreatic cancer in a state will aid in the designation of specific primary prevention measures targeted in the worst-hit communities.

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Section: Discussionmentioning

confidence: 99%

Geographical Distribution of Pancreatic Cancer in the State of Mississippi by Incidence and Mortality From 2003 to 2019

Nduma¹,

Ambe²,

Ekhator³

et al. 2022

Cureus

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“…Overall, fewer than half of patients with LPC who are treated with systemic chemotherapy undergo pancreatectomy. 3,19,45,46 Nonetheless, the focus of most available analyses is on identification of factors that predict survival among LPC patients who have undergone surgery. Few, if any, studies have focused on the predictors of longevity in the majority of patients who are treated nonoperatively.…”

Section: Discussionmentioning

confidence: 99%

Radiographic and Serologic Response to First-Line Chemotherapy in Unresected Localized Pancreatic Cancer

Hester

Perri

Prakash

et al. 2022

Journal of the National Comprehensive Cancer Network

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Background: This study aimed to determine the clinical relevance of putative radiographic and serologic metrics of chemotherapy response in patients with localized pancreatic cancer (LPC) who do not undergo pancreatectomy. Studies evaluating the response of LPC to systemic chemotherapy have focused on histopathologic analyses of resected specimens, but such specimens are not available for patients who do not undergo resection. We previously showed that changes in tumor volume and CA 19-9 levels provide a clinical readout of histopathologic response to preoperative therapy. Methods: Our institutional database was searched for patients with LPC who were treated with first-line chemotherapy between January 2010 and December 2017 and did not undergo pancreatectomy. Radiographic response was measured using RECIST 1.1 and tumor volume. The volume of the primary tumor was compared between pretreatment and posttreatment images. The percentage change in tumor volume (%Δvol) was calculated as a percentage of the pretreatment volume. Serologic response was measured by comparing pretreatment and posttreatment CA 19-9 levels. We established 3 response groups by combining these metrics: (1) best responders with a decline in %Δvol in the top quartile and in CA 19-9, (2) nonresponders with an increase in %Δvol and in CA 19-9, and (3) other patients. Results: This study included 329 patients. Individually, %Δvol and change in CA 19-9 were associated with overall survival (OS) (P≤.1), but RECIST 1.1 was not. In all, 73 patients (22%) were best responders, 42 (13%) were nonresponders, and there were 214 (65%) others. Best responders lived significantly longer than nonresponders and others (median OS, 24 vs 12 vs 17 months, respectively; P<.01). A multivariable model adjusting for type of chemotherapy regimen, number of chemotherapy doses, and receipt of radiotherapy showed that best responders had longer OS than did the other cohorts (hazard ratio [HR], 0.35; 95% CI, 0.21–0.58 for best responders, and HR, 0.55; 95% CI, 0.37–0.83 for others). Conclusions: Changes in tumor volume and serum levels of CA 19-9—but not RECIST 1.1—represent reliable metrics of response to systemic chemotherapy. They can be used to counsel patients and families on survival expectations even if pancreatectomy is not performed.

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“…These categorical interpretations have been previously used. 4 ''Surgery was not recommended'' reflects a passive absence of a recommendation for surgery. There are no means within the NCDB to delineate that a recommendation was not actively pursued or that deeper investigation was documented by the administrative data manager.…”

Section: Database and Patient Populationmentioning

confidence: 99%

“…1,5,6 Although well-selected patients who have clinical stage I/II PDAC are most likely to benefit from surgery, about half of them never receive a recommendation to undergo pancreatectomy despite the absence of a clear contraindication, and this number has not changed much in the past decade. 4,7 Prior publications have recognized racial disparities in pancreatectomy receipt, but it remains unclear if demographic differences exist with respect to rates of surgery not being recommended. 4,[8][9][10][11] As PDAC affects a disproportionately older population and has a higher incidence in Non Hispanic Black (NHB) compared with Non-Hispanic White (NHW) patients, identifying differences in rates of surgical recommendation is an important initial step to deliver more equitable treatment across different patient populations.…”

mentioning

confidence: 99%

“…1 Even among patients who undergo resection, cure is seldom obtained, with only 7% to 10% of patients surviving 5 years after resection. 1,3,4 Thus cure is a function of not only the treatment implemented, but also on the individual patient’s underlying health as well as the tumor’s innate behavior and anticipated natural history (its ‘‘tumor biology’’). Longevity is better conceptualized as the cumulative product of a thoughtful oncologic approach to treatment in patients without significant comorbidities, who are physiologically fit for surgery, and who have a favorable underlying tumor biology.…”

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confidence: 99%

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Surgical Eligibility Does Not Imply Surgical Equity

et al. 2023

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Objective: We sought to characterize differences in pancreatectomy recommendation rates to surgically eligible patients with pancreatic ductal adenocarcinoma of the pancreatic head across age and racial groups. Background: Pancreatectomy is not recommended in almost half of otherwise healthy patients with stage I/II pancreatic ductal adenocarcinoma lacking a surgical contraindication. We characterized differences in pancreatectomy recommendation among surgically eligible patients across age and racial groups. Methods: Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) patients were identified in the National Cancer Database with clinical stage I/II pancreatic head adenocarcinoma, Charlson Comorbidity Index of 0 to 1, and age 40 to 89 years. Rates of surgery recommendation and overall survival (OS) by age and race were compared. A Pancreatectomy Recommendation Equivalence Point (PREP) was defined as the age at which the rate of not recommending surgery matched the rate of recommending and completing surgery. Marginal standardization was used to identify association of age and race with recommendation. OS was compared using Kaplan-Meier and Cox regression models. Results: Among 40,866 patients, 36,133 (88%) were NHW and 4733 (12%) were NHB. For the entire cohort, PREP was 79 years. PREP was 5 years younger in NHB patients than in NHW patients (75 vs 80 years). Adjusted rates of not recommending surgery were significantly higher for NHB than for NHW patients in each age group. After adjusting for surgery recommendation, we found no difference in OS between NHW and NHB patients (hazard ratio 0.98 [95% CI 0.94-1.02]). Conclusions: PREP of NHB patients was 5 years younger than NHW patients, and in every age group, the rate of not recommending pancreatectomy was higher in NHB patients. Age and race disparities in treatment recommendations may contribute to shorter longevity of NHB patients.

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Factors Associated with Treatment and Survival of Early Stage Pancreatic Cancer in the Era of Modern Chemotherapy: An Analysis of the National Cancer Database

Cited by 16 publications

References 30 publications

Geographical Distribution of Pancreatic Cancer in the State of Mississippi by Incidence and Mortality From 2003 to 2019

Geographical Distribution of Pancreatic Cancer in the State of Mississippi by Incidence and Mortality From 2003 to 2019

Radiographic and Serologic Response to First-Line Chemotherapy in Unresected Localized Pancreatic Cancer

Surgical Eligibility Does Not Imply Surgical Equity

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