Treatment strategies and clinical outcomes of locally advanced pancreatic cancer patients treated at high-volume facilities and academic centers

Abstract

Purpose Locally advanced pancreatic cancer (LAPC) treatment has varying practice patterns with poor outcomes. We investigated treatment using single-agent chemotherapy and multiagent chemotherapy (MAC) with or without radiation therapy (RT) at high-volume facilities (HVFs) and academic centers (ACs). Methods and Materials The National Cancer Database was used to obtain data on 10,139 patients with LAPC. HVF was defined as the top 5% of facilities per number of patients treated at each facility. Univariate and multivariable (MVA) analysis Cox regressions were performed to identify the impact of HVF, AC, MAC, and RT on overall survival (OS). Results The median age of patients was 66 years (range, 22-90); 50.1% were male and 49.9% female. Of the patients, 46.1% received MAC, 53.8% received single-agent chemotherapy, 45.7% received RT, 54.3% did not receive RT, and 5% underwent surgical resection. The median follow-up was 48.8 months. On MVA, treatment at HVFs and ACs remained significantly associated with improved OS, with a hazard ratio (HR) of 0.84 ( P < .001) and 0.94 ( P = .004), respectively. The median OS for HVF treatment compared with low-volume facilities was 14.3 versus 11.2 months, respectively ( P < .001). The median OS for AC treatment versus non-AC was 12.1 versus 10.8 months, respectively ( P < .001). Additionally, on MVA, receipt of RT and MAC remained significantly associated with improved OS (HR: 0.76; P < .001; and HR: 0.73; P < .001, respectively). MVA for receipt of surgery showed that MAC is a significant predictor for receiving surgery (odds ratio: 1.29; P = .009). Conclusions Our results build on a growing literature supporting RT and MAC in treating LAPC. Additionally, we believe that—in the absence of prospective data—this makes a strong case for considering MAC with RT at ACs and HVFs for treating LAPC.

Margin negative resection and pathologic downstaging with multiagent chemotherapy with or without radiotherapy in patients with localized pancreas cancer: A national cancer database analysis

“…Though the literature reveals select studies implicating female sex in the epidemiology of PDAC [35] , [36] , there is no proven association of female sex with disease outcomes, and the result herein should be considered hypothesis-generating. Several prior reports, however, have shown an association of improved outcomes for patients managed with PDAC treated at academic or high volumes centers [37] , [38] consistent with the present study.…”

Survival equivalence in patients treated for borderline resectable and unresectable locally advanced pancreatic ductal adenocarcinoma: a systematic review and network meta-analysis

“…Further description of the characteristics of studies included is shown in Table 1 and the Supporting Information (Tables S2-S4). [15][16][17][18][19][20][21][22][23][24][25][26][27][28]38, The network included a total of 14,065 patients of whom 1772 (13%), 11,073 (79%), and 1220 (9%) were in the LA-BR, LA-UR, and UFR groups, respectively (Table S4). The network consisted of eight unique treatment subgroups and 57 pairwise comparisons (Fig.…”

“…An additional post-hoc sensitivity analysis was performed to evaluate the effect of excluding a large cohort from the National Cancer Database, which may have resulted in data duplication. 38 Prespecified sources of heterogeneity were defined in the study protocol, and subgroup analyses and meta-regression were used to explore suspected sources of heterogeneity. 39 All statistical analyses were performed using R (version 3.6.1 Action of the Toes) in RStudio (version 1.1.419).…”

The utilization and impact of adjuvant therapy following neoadjuvant therapy and resection of pancreatic adenocarcinoma: does more really matter?

“…Certainly, prior studies have demonstrated differences in care for PDAC patients treated at high volume and academic centers, including evidence of closer adherence to national guidelines at these centers. 36,37 A notable limitation to the current study is that the type and duration of chemotherapy administered (including if all planned therapy was completed) cannot be ascertained from the database. In addition, results of both the ESPAC-4 5 and PRODIGE-24 7 trials have been published subsequent to the treatment of patients included in the current analysis.…”