High-volume centers are associated with higher receipt of combined therapy in stage III pancreatic cancer - 02/05/23

Doi : 10.1016/j.amjsurg.2023.02.012

Shay Behrens ^a, Kristin Potter ^b, Ranish K. Patel ^a, Issac R. Schwantes ^a, Thomas L. Sutton ^a, Alicia J. Johnson ^a, Rodney F. Pommier ^c, Brett C. Sheppard ^a,^d,^⁎
^a Department of Surgery, Oregon Heath & Science University, Portland, OR, 97239, USA
^b School of Medicine, Oregon Heath & Science University, Portland, OR, 97239, USA
^c Division of Surgical Oncology, Department of Surgery, Oregon Heath & Science University, Portland, OR, 97239, USA
^d Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Heath & Science University, Portland, OR, 97239, USA

^∗Corresponding author. Department of Surgery, Oregon Heath & Science University, Portland, OR, 97239, USADepartment of SurgeryOregon Heath & Science UniversityPortlandOR97239USA

Abstract

Background

Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at a locally advanced stage with vascular involvement which was previously viewed as a contraindication to resection. However, high-volume centers are increasingly capable of resecting complex tumors. We aimed to explore patterns of treatment that are uncharacterized on a population level.

Methods

A statewide registry was queried from 2003 to 2018 for stage III PDAC. Stepwise logistic regression and Kaplan-Meier were used for statistical analysis.

Results

We identified 424 eligible patients. 348 (82%) received chemotherapy, 17 (4.0%) received resection, and 59 (13.9%) received both; median survival was 10.7, 8.7, and 22.7 months, respectively (P < 0.001). High-volume centers (≥20 cases per year; OR 5.40 [95% CI: 2.76, 10.58], P < 0.001) and later year of diagnosis (OR 1.12/year [95% CI: 1.04, 1.20], P = 0.004) were associated with higher odds of receiving combined therapy.

Conclusion

PDAC patients with vascular involvement who receive both systemic chemotherapy and surgical resection have improved overall survival. High-volume centers are independently associated with higher odds of receiving combined systemic therapy and surgical resection.

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Highlights

•	Chemotherapy and surgical resection improve survival in stage III PDAC.
•	Patients diagnosed at high-volume centers are more likely to receive combined chemotherapy and surgical resection.
•	Diagnosis at a high-volume center, later year of diagnosis, and younger age are associated with receipt of combined therapy.

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