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Moving the Needle in Pancreatic Cancer: The Impact of Modern Treatment Paradigm on Survival
Abdimajid Mohamed1, Timothy Fitzgerald1, Dougald Macgillivray2, Cynthia Hayward3
1Surgical Oncology, Tufts University School Of Medicine/Maine Medical Center, Portland, Maine, United States, 2Endocrine, Maine Medical Center, Portland, Maine, United States, 3Oncology, Maine Medical Center, Scarborough, Maine, United States

Objective
Seminal trials, reported in 2011, have demonstrated improved survival with novel multiagent chemotherapy regimens. To understand the clinical ramifications of this paradigm shift, we reviewed our institutional experience.

Design
Retrospective cohort study

Setting
Single institutional database.

Results
This study included 1,572 patients. Of those patients, 36% were diagnosed with pancreatic cancer before 2011 (Era 1) and 64% after 2011 (Era 2). On multivariate analysis patients in Era 2 were more likely to undergo surgery (OR 2.78;CI 2.00-3.92, p<0.001), present with locally advanced disease (OR 0.43;CI 0.29-0.63, p<0.001), or Stage IV disease (OR 0.41;CI 0.26-0.61, p<0.001). The entire cohort"s analysis demonstrated improved survival in Era 2 (Median survival 10 months vs. 8 months, HR 0.79; CI 0.69-0.91, p<0.001). Survival was similar in Era 1 and Era 2 for patients with stage IV disease (median survival 4 vs 4, HR 0.87;CI 0.71-1.08, p =0.2), T1/T2 neoplasms (median survival 19 vs 15, HR 0.88;CI 0.63-1.23, p =0.4), and for those undergoing surgery (median survival 26 vs 21, HR 0.76;CI 0.55-1.05, p =0.10). However, patients with locally advanced disease had improved survival in Era 2 (Median survival 12 vs. 10, HR 0.71; CI 0.59-0.86, p<0.001). Patients with locally advanced disease were more likely to undergo surgical resection in Era 2 (42% vs. 20%, OR 3.74; CI 2.39-6.00, p<0.001).

Conclusions
This single institutional series demonstrates an improved survival for patients with pancreatic cancer. Although survival was similar for patients with stage IV disease, early-stage disease, and those undergoing surgery, there was a marked improvement in survival for patients with locally advanced tumors. The improvement in survival may be secondary to an increase in resection after neoadjuvant therapy.


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