Underuse of surgical resection among elderly patients with early-stage pancreatic cancer

Weiguo He, Hui Zhao, Wenyaw Chan, David Lopez, Rachna T. Shroff, Sharon H. Giordano

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13 Citations (Scopus)

Abstract

Background Although surgery improves the health care quality and outcomes of patients with early-stage pancreatic cancer, these patients' operative resection rate has been historically low. We sought to identify factors that are associated with operative resection in this patient population. Methods In this retrospective population-based study, we used Texas Cancer Registry-linked and Surveillance and Epidemiology End Results Program-linked Medicare data to study factors potentially associated with operative resection in patients age ≥66 years who had been diagnosed with localized pancreatic cancer between January 1, 2001, and December 31, 2009. Variables were assessed using multivariate logistic regression and Cox proportional hazards regression models. We used Kaplan-Meier analysis to assess the effect of operative resection on survival rate. Results Of 1,501 patients with localized pancreatic cancer, only 340 (22.7%) underwent operation. Patients were more likely to undergo surgery if they were young, had small tumors, had low-grade tumors, and had nodal negativity (P < .05). Compared with patients who did not undergo surgery, patients who underwent surgery had a significantly higher 5-year overall survival rate (25.0 vs 2.3%; P < .0001) and had a higher median survival time (24.3 vs 5.8 months). Conclusion The rate of operative resection of early-stage pancreatic cancer did not increase significantly from 2001 to 2009. Although we identified several variables associated with operative resection, why the percentage of patients with localized pancreatic cancer who undergo definitive surgery is so low remains unclear.

Original languageEnglish (US)
Article number4200
Pages (from-to)1226-1234
Number of pages9
JournalSurgery (United States)
Volume158
Issue number5
DOIs
StatePublished - Nov 1 2015
Externally publishedYes

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Pancreatic Neoplasms
Survival Rate
SEER Program
Neoplasms
Quality of Health Care
Kaplan-Meier Estimate
Medicare
Proportional Hazards Models
Population
Registries
Logistic Models
Survival

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

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Underuse of surgical resection among elderly patients with early-stage pancreatic cancer. / He, Weiguo; Zhao, Hui; Chan, Wenyaw; Lopez, David; Shroff, Rachna T.; Giordano, Sharon H.

In: Surgery (United States), Vol. 158, No. 5, 4200, 01.11.2015, p. 1226-1234.

Research output: Contribution to journalArticle

He, Weiguo ; Zhao, Hui ; Chan, Wenyaw ; Lopez, David ; Shroff, Rachna T. ; Giordano, Sharon H. / Underuse of surgical resection among elderly patients with early-stage pancreatic cancer. In: Surgery (United States). 2015 ; Vol. 158, No. 5. pp. 1226-1234.
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N2 - Background Although surgery improves the health care quality and outcomes of patients with early-stage pancreatic cancer, these patients' operative resection rate has been historically low. We sought to identify factors that are associated with operative resection in this patient population. Methods In this retrospective population-based study, we used Texas Cancer Registry-linked and Surveillance and Epidemiology End Results Program-linked Medicare data to study factors potentially associated with operative resection in patients age ≥66 years who had been diagnosed with localized pancreatic cancer between January 1, 2001, and December 31, 2009. Variables were assessed using multivariate logistic regression and Cox proportional hazards regression models. We used Kaplan-Meier analysis to assess the effect of operative resection on survival rate. Results Of 1,501 patients with localized pancreatic cancer, only 340 (22.7%) underwent operation. Patients were more likely to undergo surgery if they were young, had small tumors, had low-grade tumors, and had nodal negativity (P < .05). Compared with patients who did not undergo surgery, patients who underwent surgery had a significantly higher 5-year overall survival rate (25.0 vs 2.3%; P < .0001) and had a higher median survival time (24.3 vs 5.8 months). Conclusion The rate of operative resection of early-stage pancreatic cancer did not increase significantly from 2001 to 2009. Although we identified several variables associated with operative resection, why the percentage of patients with localized pancreatic cancer who undergo definitive surgery is so low remains unclear.

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