Highlights
- •Chemotherapy and surgical resection improve survival in stage III PDAC.
- •Patients diagnosed at high-volume centers are more likely to receive combined chemotherapy and surgical resection.
- •Diagnosis at a high-volume center, later year of diagnosis, and younger age are associated with receipt of combined therapy.
Abstract
Background
Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at a locally advanced stage
with vascular involvement which was previously viewed as a contraindication to resection.
However, high-volume centers are increasingly capable of resecting complex tumors.
We aimed to explore patterns of treatment that are uncharacterized on a population
level.
Methods
A statewide registry was queried from 2003 to 2018 for stage III PDAC. Stepwise logistic
regression and Kaplan-Meier were used for statistical analysis.
Results
We identified 424 eligible patients. 348 (82%) received chemotherapy, 17 (4.0%) received
resection, and 59 (13.9%) received both; median survival was 10.7, 8.7, and 22.7 months,
respectively (P < 0.001). High-volume centers (≥20 cases per year; OR 5.40 [95% CI: 2.76, 10.58],
P < 0.001) and later year of diagnosis (OR 1.12/year [95% CI: 1.04, 1.20], P = 0.004)
were associated with higher odds of receiving combined therapy.
Conclusion
PDAC patients with vascular involvement who receive both systemic chemotherapy and
surgical resection have improved overall survival. High-volume centers are independently
associated with higher odds of receiving combined systemic therapy and surgical resection.
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Article info
Publication history
Published online: February 21, 2023
Accepted:
February 17,
2023
Received in revised form:
January 22,
2023
Received:
November 15,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
