Surgery offers the only chance of cure in non-metastatic pancreatic cancer. However, chemo- and radio-therapy also play important roles in pancreatic cancer care. How each of these different modalities of treatment impact on pancreatic cancer outcome is unclear. The National Cancer Registry (NCRI) is a publicly appointed body, established to collect and classify information on all cancer cases which occur in Ireland. We analysed these data with the objective to examine the trend of care of stage 1 to 3 pancreas cancer in Ireland.
Pancreatic cancer data have been collected by NCRI since 1994. Only those with stage 1 – 3 adenocarcinoma of the pancreas (PDAC) were included in the final analyses. Descriptive statistics, Pearson chi-square test and survival analysis using Kaplan Meier curve with log-rank test and cox regression was performed.
Between Jan 1994 and Dec 2013, of the 8230 patients with pancreatic cancer identified from the NCRI database, 4298 pts had histologically proven adenocarcinoma. Among these, 1177/27% of patients (pts) had stage 1 – 3 disease. 52% were male and 74% of pts were over 60 years of age. Stage 1, 2 and 3 disease comprised 25%, 32% and 42% of pts respectively. Overall 48 % of pts had surgery, 44% had chemotherapy and 21% had radiotherapy. 364, 31% pts did not have any therapy at all. Compared to those who did not have any treatment, there was an incremental benefit in overall survival (OS) with the more number of different modalities of treatment involved (Table). OS was 3 mos with no treatment, 8 mos with either chemo or radiation (HR 0.57), 11 mos with chemo and radiation (HR 0.46), 18 mos with surgery only (HR 0.27) and 20 mos with surgery with chemo and/or radiation therapy (HR 0.24).Table: 744P
|No treatment||364, 31%||3 months|
|Multimodality therapies including surgery||287, 25%||20 months||0.24 (95% CI: 0.20 – 0.28)|
|Surgery only||245, 21%||18 months||0.27 (95% CI: 0.22 – 0.32)|
|Multimodality therapy (no surgery)||95, 8%||11 months||0.46 (95% CI: 0.36 – 0.58)|
|Single modality therapy (no surgery)||179, 16%||8 months||0.57 (95% CI: 0.48 – 0.69)|
Multimodality therapy with surgery improves OS in non-metastatic pancreatic cancer with incremental benefit seen from even single modality therapy.
Clinical trial identification
Legal entity responsible for the study
Rozana Abdul Rahman, Ray McDermott.
Has not received any funding.
All authors have declared no conflicts of interest.