Recent Trends in Survival of Patients With Pancreatic Cancer in Germany and the United States

Sirri, Eunice; Castro, Felipe A.; Kieschke, Joachim; Jansen, Lina; Emrich, Katharina; Gondos, Ádám; Holleczek, Bernd; Katalinic, Alexander; Urbschat, I.; Vohmann, Claudia; Brenner, Hermann

doi:10.1097/mpa.0000000000000588

Cited by 82 publications

(66 citation statements)

References 35 publications

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“…The median age of patients suffering from pancreas cancer is 70 years or more[2]. Even though pancreatectomies have been proven safe for patients older than 70 years[3], significant disparities have been noted in the elderly receiving appropriate surgical treatment for pancreatic cancer[4].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive distal pancreatectomy: greatest benefit for the frail

et al. 2017

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OBJECTIVE The benefits of minimally invasive distal pancreatectomy (MIDP) over open surgery continue to be investigated. Frailty is a known predictor of postoperative outcome. We hypothesized that the benefit of minimally invasive distal pancreatectomy is greatest for the frailest of patients. METHODS Data from the pancreas-targeted National Surgical Quality Improvement Program (NSQIP) database for 2014 were reviewed. A modified frailty index (mFI) with 11 preoperative variables previously validated for use in NSQIP was used to determine the correlation between frailty and postoperative outcomes, including Clavien grade IV complications. Patients were classified into non-frail (mFI=0) or frail (mIF>0), in which they were sub-classified into mildly frail (mFI 1 or 2), or severely frail (mFI =3). RESULTS A total of 1,038 distal pancreatectomies (DP) were included in the analysis, of which 387 were minimally invasive (MIDP: laparoscopic: 285, robotic: 102), 558 open DP (ODP) and 93 MIDP converted to open (MIDPcODP: laparoscopic: 80, robotic: 13). More than 90% of patients had a mFI of 0 or 1 (mFI 0=473 (45.6%), 1=466 (44.9%), 2=94 (9.1%), and 3=5 (0.5%) respectively). Overall, 4.6% of patients experienced Clavien grade IV complications and 1.1% a mortality. Non-frail patients experienced a similar rate of grade IV Clavien complications with MIDP vs ODP vs MIDPcOP (2.3 vs. 2.3 vs. 4.9%; p=0.6), whereas frail patients (mFI>0) had a lower rate of complications with MIDP (2.4 vs. 8.3 vs. 11.5; p=0.007). Worsening frailty correlated with an increase in complications (non-frail: 2.5%; mildly frail: 6.3%; severely frail: 20%; p=0.005). CONCLUSION MIDP is associated with a lower risk of Clavien grade IV complications compared to ODP for frail patients, especially for benign disease. Thus, minimally invasive approach may mitigate risk in frail patients.

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Section: Introductionmentioning

confidence: 99%

Minimally invasive distal pancreatectomy: greatest benefit for the frail

et al. 2017

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“…Table IV shows the 5-year observed and relative survival by age group (15-34, 35-44, 45-54, 55-64, 65-74, and 75+) for all the major cancer sites. Relatively higher survival rates were observed in younger patients (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) compared with older patients (65-74, 75+), particularly for sites including the stomach, lung, pancreas, B and CNS, blood (NHL) and cervix. Cancer of the oesophagus, female breast and bladder had higher survival in middle-aged groups (45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)…”

Section: Resultsmentioning

confidence: 99%

Cancer survival in Qidong between 1972 and 2011: A population-based analysis

Chen

Zhu

Zhang

et al. 2017

Molecular and Clinical Oncology

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Abstract. Population-based cancer survival is an improved index for evaluating the overall efficiency of cancer health services in a given region. The current study analysed the observed survival and relative survival of leading cancer sites from a population-based cancer registry between 1972 and 2011 in Qidong, China. A total of 92,780 incident cases with cancer were registered and followed-up for survival status. The main sites of the cancer types, based on the rank order of incidence, were the liver, stomach, lung, colon and rectum, oesophagus, breast, pancreas, leukaemia, brain and central nervous system (B and CNS), bladder, blood [non-Hodgkin's lymphoma (NHL)] and cervix. For all malignancies combined, the 5-year observed survival was 13.18% and the relative survival was 15.80%. Females had higher observed survival and relative survival (19.32 and 22.71%, respectively) compared with males (9.63 and 11.68%, respectively). The cancer sites with the highest five-year relative survival rates were the female breast, bladder, cervix and colon and rectum; followed by NHL, stomach, B and CNS cancer and leukaemia. The poorest survival rates were cancers of oesophagus, lung, pancreas and liver. Higher survival rates were observed in younger patients compared with older patients. Cancers of the oesophagus, female breast and bladder were associated with higher survival in middle-aged groups. Improved survival rates in the most recent two 5-year calendar periods were identified for stomach, lung, colon and rectum, oesophagus, female breast and bladder cancer, as well as leukaemia and NHL. The observations of the current study provide the opportunity for evaluation of the survival outcomes of frequent cancer sites that reflects the changes and improvement in a rural area in China.

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“…However, clinicians should be mindful that surgery is the only curative option for pancreatic carcinomas (PCs), and elderly patients are often less likely to tolerate chemotherapy owing to significant age-related comorbidities. The 5-year survival rate of PCs in Germany is 10.7% and only 20% of 51 diagnosed patients are even suitable for pancreatic resection [1] . However, our study found that surgery significantly increased the 5-year survival rate of the elderly cohort to 14.1%, and there was even a trend toward higher R0 resection rates.…”

Section: Discussionmentioning

confidence: 99%

“…With reference to this demographic trend, the older patient population will inevitably be confronted with the need for surgical intervention in the future. In pancreatic surgery, it is especially important to consider these demographic changes, because there is a strong correlation between the incidence of malignant tumors and advanced age [1] .…”

Section: Introductionmentioning

confidence: 99%

Pancreaticoduodenectomy in the Elderly Patient: Age-Adapted Risk Assessment

Wiltberger¹,

Muhl²,

Benzing³

et al. 2016

Dig Surg

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Background: Older patients are increasingly faced with pancreatic surgery because of shifting demographics. The differential effects of aging on surgical outcomes remain vague, while the elderly patient is often neglected in clinical trials. Methods: Medical records of 370 patients who underwent pancreaticoduodenectomy were analyzed. Patients were then subdivided into 3 groups according to age and comorbidities. Results: Overall mortality was 5% and did not significantly differ between age-matched groups. Increasing age was linked to a higher prevalence of diabetes mellitus (p < 0.001) and preoperative cardiovascular comorbidities (p < 0.001). Independent risk factors for major complications were age over 70 years (p = 0.018; OR 2.3), elevated body mass index (p = 0.004; OR 0.2) and cardiovascular comorbidities (p = 0.022; OR = 2.6). Patients who were older (>70 years), obese and had cardiovascular disease had an increased risk of major complications when compared with the younger study population (p = 0.010). Conclusions: Pancreatic surgery in elderly patients showed similar mortality rates as in younger patients. Nevertheless, a careful risk assessment is particularly important because older patients who are considered to be high risk suffer more frequently from major surgical complications compared with young patients that have similar risk profiles.

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Recent Trends in Survival of Patients With Pancreatic Cancer in Germany and the United States

Abstract: Although pancreatic cancer survival continues to be poor for advanced-stage patients, our study disclosed encouraging indications of first improvements in 5-year RS after decades of stagnation.

Cited by 82 publications

References 35 publications

Minimally invasive distal pancreatectomy: greatest benefit for the frail

Minimally invasive distal pancreatectomy: greatest benefit for the frail

Cancer survival in Qidong between 1972 and 2011: A population-based analysis

Pancreaticoduodenectomy in the Elderly Patient: Age-Adapted Risk Assessment

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