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. 2015 Apr;261(4):740-5.
doi: 10.1097/SLA.0000000000000796.

Pancreatectomy predicts improved survival for pancreatic adenocarcinoma: results of an instrumental variable analysis

Bradley D McDowell  1 , Cole G Chapman, Brian J Smith, Anna M Button, Elizabeth A Chrischilles, James J Mezhir
Affiliations

Pancreatectomy predicts improved survival for pancreatic adenocarcinoma: results of an instrumental variable analysis

Bradley D McDowell et al. Ann Surg. 2015 Apr.

Abstract

Background and objective: Pancreatic resection is the standard treatment option for patients with stage I/II pancreatic ductal adenocarcinoma (PDA), yet many studies demonstrate low rates of resection. The objective of this study was to evaluate whether increasing resection rates would result in an increase in average survival in patients with stage I/II PDA.

Methods: SEER (Surveillance, Epidemiology, and End Results) data were analyzed for patients with stage I/II pancreatic head cancers treated from 2004 to 2009. Pancreatectomy rates were examined within Health Service Areas (HSAs) across 18 SEER regions. An instrumental variable analysis was performed, using HSA rates as an instrument, to determine the impact of increasing resection rates on survival.

Results: Pancreatectomy was performed in 4322 of 8323 patients evaluated with stage I/II PDA (overall resection rate = 51.9%). The resection rate across HSAs ranged from an average of 38.6% (lowest quintile) to 67.3% (highest quintile). Median survival was improved in HSAs with higher resection rates. Instrumental variable analysis revealed that, for patients whose treatment choices were influenced by rates of resection in their geographic region, pancreatectomy was associated with a statistically significant increase in overall survival.

Conclusions: When controlling for confounders using instrumental variable analysis, pancreatectomy is associated with a statistically significant increase in survival for patients with resectable PDA. On the basis of these results, if resection rates were to increase in select patients, then average survival would also be expected to increase. It is important that this information be provided to physicians and patients so that they can properly weigh the risks and advantages of pancreatectomy as treatment of PDA.

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Conflict of interest statement

The authors have no financial disclosures or conflicts of interest.

Figures

Figure 1
Figure 1
Instrumental Variable Analysis Controls for Unmeasured Confounding to help Determine the Impact of Raising Pancreatectomy Rates on the Marginal Patient with Pancreatic Cancer.
Figure 2
Figure 2
Map of the United States Showing Geographic Distribution of Health Service Area Quintiles. (Quintile 1 = Lowest Rate of Pancreatectomy and Increases to Quintile 5 = Highest Rate of pancreatectomy)
Figure 3
Figure 3
Kaplan-Meier Curve Showing Overall Survival by Health Services Area Quintiles for Pancreatic Head Adenocarcinoma. (Quintile 1 = Lowest Rate of Pancreatectomy and Increases to Quintile 5 = Highest Rate of pancreatectomy)
See this image and copyright information in PMC

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