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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2017

01-08-2017 | Pancreatic Tumors

Failure to Treat: Audit of an Institutional Cancer Registry Database at a Large Comprehensive Cancer Center Reveals Factors Affecting the Treatment of Pancreatic Cancer

Authors: Jennifer L. Miller-Ocuin, MD, Mazen S. Zenati, MD, Lee M. Ocuin, MD, Patrick R. Varley, MD, Stephanie M. Novak, MS, Sharon Winters, Amer H. Zureikat, MD, Herbert J. Zeh III, MD, Melissa E. Hogg, MD, MS

Published in: Annals of Surgical Oncology | Issue 8/2017

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Abstract

Background

National Cancer Database analysis showed 70% of patients with stage I pancreatic adenocarcinoma (PDA) did not have surgery. We sought to analyze adherence to expected treatment (ET) by stage for PDA and identify factors that led to no treatment (NT) or unexpected treatment (UT) in a recent cohort.

Methods

Using our Institutional Cancer Registry (ICR), we identified patients with PDA from 2004 to 2013. ET was defined as surgery ± chemotherapy ± radiation for stages I and II, chemotherapy ± radiation for stage III, and chemotherapy for stage IV, while UT was defined as no surgery for stages I and II, surgery for stage III, or ± surgery ± XRT for stage IV.

Results

Overall, 2340 patients were identified (stages I and II = 51%, stage III = 11%, stage IV = 38%; ET = 58%, UT = 18%, NT = 24%). A total of 1183 patients had resectable PDA (stages I and II; ET = 57%, UT = 27%, NT = 16%), with ET demonstrating the best overall survival, but UT showing better survival than NT (p < 0.0001). In addition, 261 patients had unresectable PDA (stage III; ET = 69%, UT = 12%, NT = 18%), and survival was best in UT, but ET had a survival advantage over NT (p < 0.0001). Finally, 896 patients had metastatic PDA (stage IV; ET = 55%; UT = 9%; NT = 36%), with the NT group showing worse survival than the ET and UT groups (p < 0.0001).

Conclusions

Unlike previous reports, most patients with early-stage disease had ET. ET and UT were associated with better survival than NT in all stages, and surgical cohorts have improved survival regardless of stage. Younger age, male sex, white race, and less comorbidity were predictors of receiving treatment.
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Metadata
Title
Failure to Treat: Audit of an Institutional Cancer Registry Database at a Large Comprehensive Cancer Center Reveals Factors Affecting the Treatment of Pancreatic Cancer
Authors
Jennifer L. Miller-Ocuin, MD
Mazen S. Zenati, MD
Lee M. Ocuin, MD
Patrick R. Varley, MD
Stephanie M. Novak, MS
Sharon Winters
Amer H. Zureikat, MD
Herbert J. Zeh III, MD
Melissa E. Hogg, MD, MS
Publication date
01-08-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-5880-9

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