Surgical resection improves survival in pancreatic cancer patients without vascular invasion- a population based study

Abstract

Aim: To investigate the effect of surgery on overall survival (measured from the time of diagnosis) in pancreatic cancer without vascular invasion (stage 1, 2A and 2B). We also sought to investigate factors that predict survival in patients who elected to undergo surgery and factors that affect the decision to undergo surgery.

Methods: The Surveillance Epidemiology and End Results (SEER) database was queried for microscopically confirmed cases of stage 1,2A and 2B pancreatic ductal adenocarcinoma diagnosed between 1973-2009. Survival analysis was carried out by univariate and multivariate analysis. Logistic regression was employed to identify factors that predict decision to undergo surgery.

Results: 1,759 patients with microscopically confirmed pancreatic cancer with stage 1-2B at the time of diagnosis were recorded in the SEER database. 92.6% patients underwent pancreatic cancer-directed surgery. Patients undergoing surgery had a significantly lower mean age at the time of diagnosis (65.8 vs. 69.9 years, P=0.002) and a longer median survival (18 vs. 7 months) compared to those who did not undergo surgery. Surgical resection was a significant predictor of overall survival upon both univariate and multivariate analysis. Younger age at the time of diagnosis, non-white, non-black race, tumor size <40 mm and tumor located in the tail of the pancreas were factors significantly associated with a chance of pancreatic cancer-directed surgery.

Conclusion: Surgery improves survival in pancreatic cancer patients where the tumor has not involved the vasculature. Younger patients, those with smaller tumors located in the tail of the pancreas were most likely to undergo surgical resection.

Keywords: Pancreatic cancer; survival; vascular invasion.

Figure 1

Kaplan-Meier analysis demonstrating effect of surgical resection on survival of patients with resectable pancreatic cancer. Patients who underwent surgery had a significantly longer median survival (18 months) compared to those who did not undergo surgery (7 months) (P<0.0001 by Log rank test)