Peritoneal Carcinomatosis: A Population-Based Study on the Predictors of Improved Survival
*Nensi M. Ruzgar, *Holly N. Blackburn, *Anup Sharma, Nita Ahuja
Yale University School of Medicine, New Haven, CT
Objective: The population burden and mortality of peritoneal carcinomatosis (PC) remain largely understudied. Here, we aim to identify demographic and clinical factors associated with survival in this cohort. Design: Retrospective analysis of a population-based cohort. Setting: SEER-18, representing≥34.6% of U.S. population. Patients: From 2004-2016, 347,819 patients with PC were identified. Synchronous presentations with primary tumor (sPC) and metachronous presentations ≥3 months after primary diagnosis (mPC) were matched based on twenty most frequently presenting primary sites. Main outcome measures: All-cause mortality. Results: 278,858 sPC and 30,040 mPC patients were compared. Median interval to mPC after primary diagnosis was 70 months. Both groups had a median 4-month survival (sPC: 95%CI=3.97-4.03, mPC: 95%CI=3.90-4.10; p=0.829). Overall, survival was worse in males (M=4 months, 95%CI=3.96-4.04; F=5, 95%CI=5.94-5.06, p<0.001), patients≥65 years (older=3, 95%CI=2.97-3.03; younger=7, 95%CI=6.92-7.08; p<0.001), and Medicaid-insured (4, 95%CI=3.91-4.09) compared to privately insured (5, 95%CI=4.95-5.05; p<0.001). Primary digestive and respiratory cancers with sPC had the shortest survival of 3 (95%CI=2.95-3.05) and 4 months (95%CI=3.95-4.05) respectively, while breast cancer had the longest survival (23 months, 95%CI=22.12-23.88; p<0.001). Survival after mPC ranged with primary site from 3 months (primary non-ovarian reproductive cancers, 95%CI=2.85-3.15) to 6 (ovarian, 95%CI=4.36-7.64; p<0.001). Survival after sPC varied with primary tumor treatment: 24 months for en-bloc resections (95%CI=23.46-24.54), 18 for anatomic resections (95%CI=17.36-18.64), 9 for local treatment (95%CI=8.58-9.42), and 3 for no treatment (95%CI=2.97-3.03; p<0.001). Patients who underwent surgery on metastases survived longer (surgery=10 months, 95%CI=9.74-10.26; no surgery=4, 95%CI=3.97-4.03; p<0.001). Conclusions: National trends for PC show mortality disparities based on age, sex, and insurance, and longer survival with surgical management. Our results demonstrate underrepresentation of mPC in SEER and emphasize the need to elucidate mechanisms mediating these disparities.
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