National Use of Chemotherapy in Initial Management of Stage I Pancreatic Cancer and Failure to Perform Subsequent Resection
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Chemotherapy is increasingly administered prior to resection in patients with early-stage pancreatic adenocarcinoma, but the national prevalence of this practice is poorly understood. Our objectives were to (1) describe the utilization of upfront chemotherapy management of stage I pancreatic cancer; (2) define factors associated with the use of upfront chemotherapy and subsequent resection; and (3) assess hospital-level variability in upfront chemotherapy and subsequent resection.
The National Cancer Database was used to identify patients treated for clinical stage I pancreatic adenocarcinoma. Outcomes were receipt of upfront chemotherapy and surgical resection after upfront chemotherapy. Associations between patient/hospital factors and both initial management and subsequent resection were assessed by multivariable logistic regression.
A total of 17,495 patients were included, with 26.6% receiving upfront chemotherapy. Upfront chemotherapy was more likely in patients who were ≥ 80 years of age (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.39–1.93), had T2 tumors (OR 2.56, 95% CI 2.36–2.78), or were treated at a low-volume center (OR 2.10, 95% CI 1.63–2.71). Among patients receiving upfront chemotherapy, only 33.5% underwent subsequent resection. Resection was more likely in patients with T1 tumors (OR 1.22, 95% CI 1.04–1.43) and in those treated at high-volume centers (OR 4.03, 95% CI 2.90–5.60). Only 20.4% of hospitals performed resection in > 50% of patients after upfront chemotherapy.
Rates of surgical resection after upfront chemotherapy are relatively low, and the proportion of patients who eventually undergo resection varies considerably between hospitals. The use of surgery after upfront chemotherapy in resectable pancreatic cancer should be considered as an internal quality-of-cancer-care measure.
As an organization, the American College of Surgeons had no role in the design and conduct of the study; analysis and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The views expressed in this work represent those of the authors only. RJE (Agency for Healthcare Research and Quality [AHRQ] 5T32HS000078) was supported by a postdoctoral research fellowship and the American College of Surgeons Clinical Scholars in Residence Program. RPM is supported by the Agency for Healthcare Quality (K12HS023011) and an Institutional Research Grant from the American Cancer Society (IRG-18-163-24). ADY is supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (K08HL145139).
The authors report no conflicts of interest, financial or otherwise, related to this work.
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