The impact of curative intent surgery on the survival of pancreatic cancer patients: A US Population-based study

OBJECTIVES: Pancreatic cancer is the fourth leading cause of cancer death in the United States. Curative intent surgery (CIS) is presumed to be the only curative option in the treatment of pancreatic cancer. The determinants and the outcomes of surgical resection are not clear at the population level. METHODS: Using data from nine registries of the Surveillance Epidemiology and End Results (SEER) program, we examined the predictors of receiving CIS as well as the survival of patients receiving CIS between 1987 and 2001. The definition of CIS in SEER is accurate and has been previously validated and found to be highly accurate. Cox proportional hazard model was used to examine the effect of potential determinants on survival. RESULTS: We identified 32,348 cases of pancreatic cancer. Of those, 3,545 ( 10.9%) received CIS. The proportion of patients receiving CIS decreased significantly with age ( P < 0.0001), was similar across all racial groups ( 10.8% in whites, 11.4% in blacks, 11.5% in Asians, and 11.2 % in Hispanics, P = 0.5), was slightly higher in men ( 11.3% vs 10.5%, P = 0.02), decreased with advanced disease stage ( P < 0.0001), progressively increased over time ( 7.5% in 1987 - 89, 9.1% in 1990 - 92, 10.4% in 1993 - 95, 12.4% in 1996 - 98, and 13.4% in 1999 - 2001, P < 0.0001), and differed significantly across different SEER registries ( 9.7% in San Francisco, 11.8% in Connecticut, 12.5% in Detroit, 11.7% in Hawaii, 9.3% in Iowa, 10.05% in New Mexico, 9.5% in Seattle, 13.2% in Utah, 11.4% in Atlanta, P < 0.0001). In the multivariable logistic regression analysis, more recent time periods, younger age, early disease stage, and geographic location, but not race or gender, were independent predictors of receiving CIS. In the Cox survival analysis, younger age, early disease stage, more recent time period, geographic location, and receipt of CIS were independent predictors of improved survival and black race was an independent predictor of shorter survival. CONCLUSIONS: Early stage disease, female gender, younger age, geographic location, and more recent time periods are predictors of receiving CIS. Early disease stage and receipt of CIS are the strongest predictors of improved survival among patients with pancreatic cancer. Black race is an independent predictor of shorter survival.