Survival trends of patients with metastatic pancreatic cancer: A Surveillance Epidemiology and End Results registry trend analysis from 1988 to 2008.

Gastrointestinal (Noncolorectal) Cancer
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This abstract will not be presented at the 2012 ASCO Annual Meeting but has been published in conjunction with the meeting.
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J Clin Oncol 30, 2012 (suppl; abstr e14544)
Mathias Worni, Ulrich Guller, Rebekah Ruth White, Ricardo Pietrobon, Thomas Cerny, Beat Gloor, Dieter Koeberle; Duke University Medical Center, Department of Surgery, Durham, NC; Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; University Hospital Bern, Department of Visceral Surgery and Medicine, Bern, Switzerland

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Background: Pancreatic adenocarcinoma (PAC) is a disease with dismal prognosis. Only a minority of patients with PAC presents with a resectable tumor and can potentially be cured. Therapeutic options for non-resectable, metastatic tumors are limited and chemotherapy with or without radiation is purely palliative. The aim of the present study was twofold: first, to evaluate predictors of overall survival (OS), and second, to assess trends in OS and in the use of palliative radiotherapy among patients with metastatic PAC. Methods: Patients with metastatic PAC were extracted from the SEER cancer registry from 1988 to 2008. While SEER does contain information regarding radiotherapy and surgery, data on chemotherapy cannot be ascertained. Predictors and trends of OS were assessed using univariate and multivariable Cox proportional hazard models. The trend in use of radiotherapy was analyzed using univariate and multivariable logistic regression models. Results: Overall, 23,387 patients were included (mean age: 68.0±11.8 years); 47.0% of patients were female, tumor location was in the pancreatic head in 57.7% of all patients. Median OS was 3 months. In risk-adjusted analyses, tumor location in the pancreatic body/tail was associated with worse overall survival compared to tumors of the pancreatic head (HR: 1.10, CI: 1.07-1.13, p<0.001). Increasing age, African-American ethnicity, male gender, and non-married civil status were associated with significantly worse OS. From 1988 to 2008, OS increased from a median survival of 2 (95% CI: 2-2) to 3 months (CI: 3-4) months (HR per year: 0.978, CI: 0.976-0.981, p<0.001). From 1988 to 2008, radiotherapy use decreased from 13.2% to 5.8% (adj. OR per year: 0.95, CI: 0.93-0.96, p<0.001). Conclusions: Metastatic PAC remains a disease with poor prognosis with only minimal improvement in OS over a 20-year time-period. The use of palliative radiotherapy has decreased. Tumor location in the body/tail of the pancreas, increasing age, African-American ethnicity, male gender, and non-married civil status were associated with worse OS. Future research is needed to improve OS of metastatic PAC on a population-based level.