Geographical Location Linked To Post-Resection Survival In Early Pancreatic Cancer

Research highlights the regional variation in outcomes following surgical resection in patients with early-stage pancreatic adenocarcinoma

medwireNews: Among the various socioeconomic factors associated with the likelihood of undergoing resection for early-stage pancreatic cancer, only geographical location is predictive of subsequent disease-specific survival, find US researchers.

Using the Surveillance, Epidemiology, and End Results database, they identified 17,530 patients diagnosed with stage T1 to T3 nonmetastatic pancreatic adenocarcinoma between 2004 and 2011.

During this time period, the surgical resection rate remained unchanged at 45.4%, report Jason Gold, from VA Boston Healthcare System in West Roxbury, Massachusetts, and colleagues in JAMA Surgery.

Multivariate analysis showed that resection was significantly less likely to be carried out in African–American compared with White patients (odds ratio [OR]=0.76) and in Hispanic versus non-Hispanic patients (OR=0.72).

On the other hand, the probability of undergoing resection was significantly higher in married than in single patients (OR=1.42). This was also the case for insured versus uninsured patients (OR=1.63) and those living in the Northeast compared with the Southeast (OR=1.67).

Surgical resection significantly prolonged disease-specific survival, from a median of 6 months in those not undergoing the procedure to 21 months among those who did, equating to a hazard ratio (HR) for disease-specific mortality of 0.32.

But after adjusting for tumour characteristics and receipt of external beam radiation, the only socioeconomic variable significantly and independently associated with disease-specific survival was geographical location. Compared with patients located in the Southeast, those in the Pacific West, Northeast and Midwest all had significantly improved survival, with HRs of 0.706, 0.766 and 0.765, respectively.

“Further validation of regional differences in survival after resection of pancreatic cancer and study of the reasons accounting for these differences are needed”, concludes the team.

Commentators Daniel Anaya and Mokenge Malafa, from H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, USA, say that despite the limitations of the study – such as the lack of data on variables related to resectability and survival – the findings are “critical to improve our understanding of disparities in cancer care.”

They add: “Going forward, parallel efforts should be geared to continue improving treatment options and delivery of care for pancreatic cancer—from a public health perspective, however, efforts targeted at improving the delivery of care are likely to have a higher impact in the short term than any other current intervention.

“Improving regionalization of pancreatic cancer care by increasing access to referral centers and standardizing evidence-based multidisciplinary care at these referring sites should be the focus of future interventions.”

References

Shapiro M, Chen Q, Huang Q, et al. Associations of Socioeconomic Variables With Resection, Stage, and Survival in Patients With Early-Stage Pancreatic Cancer.JAMA Surg 2015; Advance online publication 18 November. doi:10.1001/jamasurg.2015.4239

Anaya DA, Malafa M.Outcome Disparities in Pancreatic Cancer. Need for Improved Regionalization of Care. JAMA Surg 2015; Advance online publication 18 November. doi:10.1001/jamasurg.2015.4221

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