Pancreatic cancer in the general population: Improvements in survival over the last decade

Background: It is unknown whether the improved survival seen at high-volume centers has been translated to all patients with pancreatic cancer. Objective: To use the Surveillance, Epidemiology, and End Results (SEER) database to evaluate population-based trends in surgical resection and survival. Methods: All patients diagnosed with pancreatic cancer from 1988-1999 were identified. The survival and proportion of patients undergoing surgical resection were compared for each of three equal time periods. Results: There were 24,016 patients with pancreatic cancer. 19,533 had stage data available. 9% had localized, 29% had regional, and 62% had distant disease. Resection rates increased for patients with localized and regional disease over the three time periods. Survival increased for patients with regional and distant disease. For regional pancreatic cancer patients, 2-year survival increased from 9.5% to 13.5% (p<0.0001) and from 21.5% to 28.9% following surgical resection (p=0.002). For resected local/regional pancreatic cancer, the year of diagnosis was and independent predictor of improved survival (p=0.0001). Conclusions: SEER patients with regional and distant pancreatic cancer have improved survival over the past decade in both unadjusted and adjusted models. The improvement is most striking for patients with regional disease and reflects increased resection rates and improved resection techniques over time.