Real World Data for Pancreatic Adenocarcinoma from a Population-Based Study in France

Abstract

Pancreatic cancer is associated with high mortality rates, and most cases are diagnosed at advanced stages. This study aimed to evaluate the prognostic factors for survival in pancreatic adenocarcinoma. Data from the Finistere registry of digestive database were used in this analysis. This retrospective population-based study included 2117 patients with pancreatic adenocarcinoma diagnosed between 2005 and 2019. Cox regression was used to assess the impact of different prognostic factors. The overall median age was 74 (IQR 65.0−81.0). The majority of pancreatic adenocarcinoma 1120 (52.90%) occurred in the head of the pancreas. The type of surgical resection correlated with age (pancreaticoduodenectomy performed in 13.39% of patients aged under 65 years and only 1.49% of patients aged ≥ 80 years). For the entire cohort, 1-year mortality rate after diagnosis was 77.81%. Chemotherapy was associated with better survival for both operated (HR 0.17 95% CI 0.22; 0.64 p < 0.001) and unoperated patients (HR 0.41 95% CI 0.27; 0.61 p < 0.001). Palliative radiotherapy was associated with improved survival (HR 0.69 95% CI 0.56; 0.85 p < 0.001). Among operated patients, the presence of lung metastases (median 34.06; CI 20.06; 34.66) was associated with better survival compared with liver metastases (median 21.10; CI 18.10; 28.96), peritoneal carcinomatosis (median 11.00; CI 8.53; 14.63), or distant metastases (median 15.16; CI 12.66; 18.13) (p = 0.0001). Age, curative surgery, positive lymph nodes, chemotherapy, and palliative radiotherapy were corelated with overall survival. Surgical resection is the only potentially curative treatment, but less than a quarter of patients were eligible.

Keywords: chemotherapy; metastasis; pancreatic adenocarcinoma; radiotherapy; surgery; survival.

Figure 1

Flowchart of patients included in the study.

Figure 2

Incidence of pancreatic cancer.

Figure 3

(A) Survival rates stratified by age groups (up to 65 years (median 7.33, 95% CI 6.20 to 8.20), 65–80 years (median 4.53, 95% CI 3.83 to 4.93), >80 years (median 2.63, 95% CI 2.23 to 3.13), Log-rank p < 0.0001)). (B) Survival rates stratified by treatment (surgery (median 15.56, 95% CI 13.50 to 18.10), internal by-pass (median 5.86, 95% CI 4.40 to 7.16), exploratory laparotomy (median 7.26, 95% CI 5.33 to 8.40), no surgery (median 3.03, 95% CI 2.70 to 3.36), Log-rank p < 0.0001)).