Nationwide trends over 10 years in epidemiology and management of pancreatic ductal adenocarcinoma: a real-world study from the French administrative database. - 21/07/24

Doi : 10.1016/j.clinre.2024.102426

Mas Léo ^1,^⁎ , Castelli Christel ², Coffy Amandine ², Tretarre Brigitte ³, Piquemal David ⁴, Bachet Jean-Baptiste ¹
¹ Sorbonne University, AP-HP, Hépato-Gastroenterology et Digestive Oncology department, Pitié-Salpêtrière University Hospital, 75013 Paris, France
² AESIO SANTE Department Clinical Research team, Beau Soleil clinic, 34070 Montpellier, France
³ Herault Cancer network, Val d'Aurelle, 34298 Montpellier, France
⁴ Acobiom, 34790 Montpellier, France

^⁎Corresponding author: Dr Léo Mas; Department of Hepato-Gastroenterology and Digestive Oncology, Pitié Salpêtrière Hospital, APHP; 47-83 Boulevard de l'Hôpital, 75013 Paris, France; Tel.: +33 (0)1 42 16 10 41, Fax: +33 (0)1 42 16 12 38Department of Hepato-Gastroenterology and Digestive Oncology, Pitié Salpêtrière HospitalAPHP47-83 Boulevard de l'Hôpital,Paris75013France

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Highlights

•	Nationwide analysis of PDAC real-world treatments and outcomes over 10 years
•	Nearly 30 000 patients included between 2009 and 2018
•	Confirmation of the rising incidence of PDAC mainly among patients > 60 years
•	Significant increase of neoadjuvant strategies and chemotherapy delivery
•	Improved outcomes in treated patients and modest survival gain overall

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ABSTRACT

Background & aims

Significant progress has been made in the management of pancreatic ductal adenocarcinoma (PDAC) in recent years. In this population-based study, we aimed to compare incidence, therapeutic strategies, and survival outcomes of PDAC patients in France over a decade.

Methods

This study was performed using a nationwide French database. All patients receiving care for PDAC during years 2009, 2014 and 2018 were included. Treatment modalities and survival outcomes were analyzed.

Results

A total of 8143/8771/10494 patients were considered in 2009/2014/2018, respectively. Incidence increased mainly among patients aged >60 years. In localized PDAC, the proportion of patients receiving best supportive care (BSC) only decreased at 43.6/36.4/32.4% and 27.8/29.1/34.3% received chemo(radio)therapy alone. The rate of upfront surgery remained stable while 3/8/18% of operated patients received neoadjuvant therapy. Median overall survival (OS) was 7.0/7.9/8.5 months in the overall population. Among treated patients, 1-year OS was 61.4/67.7/68.8% and 30.3/36.3/38.8% for localized and metastatic PDAC, respectively.

Conclusions

This study confirms the rising incidence of PDAC. Improved outcomes were seen in localized PDAC, with a wider use of chemotherapy and neoadjuvant strategies, and in treated metastatic patients. A modest survival gain was seen overall, hindered by the still high rate of patients receiving BSC only.

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Keywords : PDAC, Incidence, Therapeutic strategies, Population-based