TY - JOUR
T1 - Understaging of clinical stage I pancreatic cancer and the impact of multimodality therapy
AU - Baugh, Katherine A.
AU - Tran Cao, Hop S.
AU - van Buren, George
AU - Silberfein, Eric J.
AU - Hsu, Cary
AU - Chai, Christy
AU - Barakat, Omar
AU - Fisher, William E.
AU - Massarweh, Nader N.
N1 - Funding Information:
This was a retrospective cohort study using the National Cancer Data Base (NCDB). The NCDB is a prospectively maintained, hospital-based registry collecting data on more than 70% of incident cancers diagnosed annually. Data are contributed from more than 1,500 Commission on Cancer–accredited centers in the United States. The NCDB is a joint project of the American College of Surgeons Commission on Cancer and the American Cancer Society. This study was approved by the institutional review board of the Baylor College of Medicine and the Michael E DeBakey VA Medical Center Research & Development Committee. This study is reported in accordance with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.
Funding Information:
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, Baylor College of Medicine, or the American College of Surgeons Commission on Cancer. The data used in this study are derived from a de-identified National Cancer Database file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data. The authors have no conflicts of interest to disclose.
Publisher Copyright:
© 2018
PY - 2019/2
Y1 - 2019/2
N2 - Background: Although current guidelines recommend multimodal therapy for all patients with pancreatic ductal adenocarcinoma, it is unclear the extent to which clinical stage I patients are accurately staged and how this may affect management. Methods: In this retrospective cohort study of 4,404 patients aged 18–79 years with clinical stage 1 (ie, T1N0 or T2N0) pancreatic ductal adenocarcinoma treated with upfront resection in the National Cancer Database (2004–2014), understaging was ascertained by comparing pretreatment clinical stage with pathologic stage. The association between adjuvant treatment and overall risk of death among true stage I and understaged patients was evaluated using multivariable Cox regression. Results: Upstaging was identified in 72.6% of patients (62.8% T3/4, 53.9% N1) of whom 69.7% received adjuvant therapy compared with 47.0% with true stage I disease. Overall survival at 5 years among those with true stage I disease was significantly higher than those who had been clinically understaged (42.9% vs 16.6%; log-rank, p < 0.001). For true stage I patients, adjuvant therapy was not associated with risk of death (hazard ratio: 1.07, 95% confidence interval: 0.89–1.29). For understaged patients, adjuvant therapy significantly decreased risk of death (hazard ratio: 0.64, 95% confidence interval: 0.55–0.74). Conclusion: The majority of clinical stage I pancreatic ductal adenocarcinoma patients actually have higher-stage disease and benefit from multimodal therapy; however, one third of understaged patients do not receive any adjuvant treatment. Clinicians should discuss all potential treatment strategies with patients (in the context of the acknowledged risks and benefits), including the utilization of neoadjuvant approaches in those presenting with potentially resectable disease.
AB - Background: Although current guidelines recommend multimodal therapy for all patients with pancreatic ductal adenocarcinoma, it is unclear the extent to which clinical stage I patients are accurately staged and how this may affect management. Methods: In this retrospective cohort study of 4,404 patients aged 18–79 years with clinical stage 1 (ie, T1N0 or T2N0) pancreatic ductal adenocarcinoma treated with upfront resection in the National Cancer Database (2004–2014), understaging was ascertained by comparing pretreatment clinical stage with pathologic stage. The association between adjuvant treatment and overall risk of death among true stage I and understaged patients was evaluated using multivariable Cox regression. Results: Upstaging was identified in 72.6% of patients (62.8% T3/4, 53.9% N1) of whom 69.7% received adjuvant therapy compared with 47.0% with true stage I disease. Overall survival at 5 years among those with true stage I disease was significantly higher than those who had been clinically understaged (42.9% vs 16.6%; log-rank, p < 0.001). For true stage I patients, adjuvant therapy was not associated with risk of death (hazard ratio: 1.07, 95% confidence interval: 0.89–1.29). For understaged patients, adjuvant therapy significantly decreased risk of death (hazard ratio: 0.64, 95% confidence interval: 0.55–0.74). Conclusion: The majority of clinical stage I pancreatic ductal adenocarcinoma patients actually have higher-stage disease and benefit from multimodal therapy; however, one third of understaged patients do not receive any adjuvant treatment. Clinicians should discuss all potential treatment strategies with patients (in the context of the acknowledged risks and benefits), including the utilization of neoadjuvant approaches in those presenting with potentially resectable disease.
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U2 - 10.1016/j.surg.2018.08.003
DO - 10.1016/j.surg.2018.08.003
M3 - Article
C2 - 30243481
AN - SCOPUS:85053633400
SN - 0039-6060
VL - 165
SP - 307
EP - 314
JO - Surgery (United States)
JF - Surgery (United States)
IS - 2
ER -