Journal article
Effect of geographic variability for pancreatectomy rates on outcomes in patients with stage I and II pancreatic adenocarcinoma
Journal of clinical oncology, Vol.31(4_suppl), pp.240-240
02/01/2013
DOI: 10.1200/jco.2013.31.4_suppl.240
Abstract
240 Background: Low usage of pancreatectomy for stage I/II pancreatic cancer in the US has been reported, yet it is not clear to what extent this reflects underutilization of resection versus appropriate selection of operative candidates. To address this, we examined the geographic variation in pancreatectomy. Methods: We queried the US Surveillance, Epidemiology, and End Results (SEER) data for stage I/II pancreatic head cancer diagnosed from 2004-2009. Factors included in multivariate analyses (MVA) were age, gender, race, stage, and geographic region and primary endpoints were rate of pancreatectomy and median survival. Results: 10,520 patients with stage I (n=2,068) and stage II (n=8,452) pancreatic head cancer were analyzed. Pancreatectomy was performed in 528 patients (25.5%) with stage I disease and in 4,295 patients (50.8%) with stage II disease (overall resection rate=45.9%). Rates of resection significantly varied across the 18 SEER regions after controlling for age, gender, race, and stage in MVA (p<0.0001). For the analysis, SEER regions were divided into groups of high/medium/low rates of resection (56.3%, 46.6%, and 41.1%, respectively). Median survival in the high resection regions was 12 months, which was significantly longer than in low and medium resection regions (both=10 months, p<0.0001). MVA confirmed that regions with high resection rates have improved survival while controlling for age, gender, and race (Table). Conclusions: Pancreatectomy rates vary highly across geographic regions, and areas with higher rates of resection are associated with better outcome. These data may reflect poor adherence to treatment guidelines, which possibly reflects a lack of confidence in the effectiveness of pancreatectomy or expertise in performing the procedure. Studies that control for patient selection factors are underway to further elucidate these important findings. [Table: see text]
Details
- Title: Subtitle
- Effect of geographic variability for pancreatectomy rates on outcomes in patients with stage I and II pancreatic adenocarcinoma
- Creators
- Bradley D McDowell - University of Iowa Hospitals and Clinics, Iowa City, IAJames R Howe - University of Iowa Hospitals and Clinics, Iowa City, IAElizabeth A Chrischilles - University of Iowa College of Public Health, Iowa City, IAJames J Mezhir - Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
- Resource Type
- Journal article
- Publication Details
- Journal of clinical oncology, Vol.31(4_suppl), pp.240-240
- DOI
- 10.1200/jco.2013.31.4_suppl.240
- ISSN
- 0732-183X
- eISSN
- 1527-7755
- Language
- English
- Date published
- 02/01/2013
- Academic Unit
- Surgery; Pharmacy; Epidemiology; Holden Comprehensive Cancer Center
- Record Identifier
- 9984214830802771
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