Diagnostic intervals and pancreatic ductal adenocarcinoma (PDAC) resectability: a single-center retrospective analysis

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) often presents with nonspecific symptoms and the workup is not standardized. To study the impact of delays in diagnosis and in the initiation of treatment, we investigated the relationship between length of diagnostic intervals and surgical resectability.

Methods: We performed a retrospective chart review of patients evaluated for PDAC at Johns Hopkins in 2014. Data were collected on the patient (date of first symptoms-first medical appointment), diagnostic (first medical appointment-diagnosis of PDAC), and treatment (diagnosis of PDAC-1st day of treatment) time intervals, and the upfront treatment received. Asymptomatic patients diagnosed incidentally, or for whom records were incomplete, were excluded from analysis.

Results: Of 453 charts reviewed, 116 patients met inclusion criteria. The median patient interval was 14 days [interquartile range (IQR): 6-30 days], the median diagnostic interval was 22 days (IQR: 8-46 days), and the median treatment interval was 26 days (IQR: 15-35 days). Thirty-eight patients (33%) received upfront surgery and 78 (67%) received nonsurgical treatment. After adjusting for multiple factors, the odds of receiving surgery significantly increased for individuals with a patient interval of 30 days or less [adjusted odds ratio (aOR): 3.41; 95% confidence interval (CI): 1.08-13.20; P=0.050] and with a diagnostic interval of 60 days or less (aOR: 15.68; 95% CI: 2.95-291.00, P=0.009).

Conclusions: A patient interval less than 1 month and a diagnostic interval less than 2 months for symptomatic PDAC are associated with increased odds of upfront surgical resection. These data provide initial evidence that reducing diagnostic delays may lead to improved outcomes in PDAC.

Keywords: Pancreatic ductal adenocarcinoma (PDAC); diagnostic delay; diagnostic intervals; surgical resection.

Figure 1

Patient, diagnostic, and treatment intervals for all 116 patients included in the analysis. The zero-day time point for each patient represents the first reported symptoms of pancreatic cancer. The median interval for all patients (including patient, diagnostic, and treatment intervals) is 74 days (black line).

Figure 2

Percent of patients (n=116) treated with upfront surgical resection (surgical) or chemotherapy/radiation (nonsurgical) in relation to patient intervals and diagnostic intervals. Odds of upfront surgery were increased for patients who had a patient interval of less than or equal to 30 days [adjusted odds ratio (aOR): 3.41, P=0.050], and a diagnostic interval of less than or equal to 60 days (aOR: 15.68, P=0.009).