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. 2018 Jul 5:10:1907-1918.
doi: 10.2147/CMAR.S167103. eCollection 2018.

Benefit from the inclusion of surgery in the treatment of patients with stage III pancreatic cancer: a propensity-adjusted, population-based SEER analysis

Lai Wang #  1   2 , Chien-Shan Cheng #  1   2 , Lianyu Chen  1   2 , Zhen Chen  1   2
Affiliations

Benefit from the inclusion of surgery in the treatment of patients with stage III pancreatic cancer: a propensity-adjusted, population-based SEER analysis

Lai Wang et al. Cancer Manag Res. .

Abstract

Purpose: In the past 20 years, surgical resection has been a secure and applicable procedure for pancreatic cancer (PC), but it remains controversial for stage III PC with data evaluating its efficacy mostly derived from small randomized trials. Hence, we designed this study to further evaluate its benefit using surveillance, epidemiology, and end results dataset.

Patients and methods: Patients with stage III PC were identified in the surveillance, epidemiology, and end results registries from 2004 to 2014. The effect of surgery on cancer-specific survival was assessed by risk-adjusted Cox proportional hazard regression modeling and propensity score matching.

Results: Overall, 6,138 patients with stage III PC were included. Of these, 608 patients underwent primary tumor surgery. On multivariable analyses, surgery was independently associated with improved cancer-specific survival (HR=0.580; 95% CI=0.523-0.643, p<0.001). The survival benefit with surgery was also observed in the propensity score-matched cohort (HR=0.501; 95% CI=0.438-0.573, p<0.001).

Conclusion: Primary tumor surgery is associated with improved survival in stage III PC. Prospective randomized trials are needed to confirm these results, and further efforts are required to address patient selection.

Keywords: and end results (SEER) database; epidemiology; propensity score matching; stage III pancreatic cancer; surgery; surveillance.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart for the creation of the SEER patient dataset. Abbreviations: AJCC, American Joint Committee on Cancer; ICD-O-3, International Classification of Diseases for Oncology, Third Edition; SEER, Surveillance, Epidemiology and End Results.
Figure 2
Figure 2
Distribution of propensity score before and after propensity score analysis. Notes: Left upper and lower panel show the distribution of the propensity score for patients with and without resection of the primary tumor before the matching procedure. Right upper and lower panel demonstrate the distribution of the propensity score after full propensity score matching.
Figure 3
Figure 3
Kaplan–Meier curve of CSS comparing the surgery group with the nonsurgery group before (A) and after (B) PSM. Abbreviations: CSS, cancer-specific survival; PSM, propensity score matching.
See this image and copyright information in PMC

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