Treatment and survival rates of stage IV pancreatic cancer at VA hospitals: a nation-wide study

Abstract

Background: Metastatic pancreatic cancer (MPC) is associated with an extremely high mortality. Current NCCN guidelines recommend systemic therapy, as it is superior to best supportive care. Undertreatment of MPC continues to be an issue. Recent treatment and survival data of MPC in Veterans' Affairs' (VA) hospitals have not been published. The relationship between MPC treatment and survival and the American College of Surgeons' (ACS) Committee on Cancer (CoC) accreditation in VA hospitals has not been studied. Methods: Nationwide data from the National Veterans Affairs Cancer Cube Registry was analyzed. In total, 6,775 patients were diagnosed with MPC between 2000 and 2014. CoC accreditation of each VA hospital was obtained using the ACS website. Results: MPC constitutes 52.31% of all pancreatic cancer diagnosed (6,775/12,951 cases). The near totality was men (97.44%). The above 70 years age group and the 60-70 years age group were the most common ages at diagnosis with 39.39% and 38.02% respectively. The proportion of early-onset pancreatic cancer (EOPC) was 2.84%. When compared to all stages of pancreatic cancer, stage IV pancreatic cancer had a lower proportion of cancer originating from the head of the pancreas (39.33% versus 50.63%) and more originating from the tail (17.99% versus 13.39%). Tumors originating from head of the pancreas are more likely to cause biliary symptoms and thus are more likely to be caught at an earlier stage. Overall, treatment rate in the VA at the national level with first-line chemotherapy was 37.61%. The rate of treatment over the years has increased in a linear fashion from 33.01% in 2000 to 41.95% in 2014. This has corresponded with an increase of 1-5 years survival of 9.29% in 2000 to 22.99% in 2014 and 5-10 years survival from 0.96% in 2000 to 6.00% in 2012. Treatment rates in CoC-accredited and non-CoC accredited VA hospitals were similar (38.94% and 38.12%, respectively). Survival rates in CoC-accredited and non-COC accredited VAs were similar with a 1-5 years survival rate of 8.89% and 8.57%, respectively. Conclusions: Treatment and survival of MPC have risen significantly in the past decade at VA hospitals.CoC accreditation is not associated with a change in treatment or survival rates.

Low Systemic Inflammation Response Index Predicts Good Prognosis in Locally Advanced Pancreatic Carcinoma Patients Treated with Concurrent Chemoradiotherapy

“…This was mainly due to the selection of patients who were decided to undergo CRT by our institutional gastrointestinal tumors board. In any case, still, because the 11.4 months OS of SIRI ≥1.6 cohort observed here was essentially similar to the survival durations reported for metastatic PCs [ 38 ], it is prudent to contemplate that chemotherapy alone or induction chemotherapy trailed by chemoradiotherapy, or upfront SBRT may represent wiser treatment choices in selected cases, which may spare such patients from the futile complications of the unnecessary chemoradiotherapy.…”

Do Better Operative Reports Equal Better Surgery? A Comparative Evaluation of Compliance With Operative Standards for Cancer Surgery

“…In a study of pancreatic cancer, Azar et al found that survival rates were similar between CoC and non-CoC institutions. 4 Improved lung cancer survival was found to be associated with high volume rather than CoC status by David et al 5 Other studies have shown that lymph node yield is associated with increased survival in colon and gastric cancer both with and without regard to CoC status. 11,12 Only 1 prior report by Zhao et al has investigated an association between gastric cancer survival and adherence to essential elements of gastric cancer surgery found in the second volume of Operative Standards for Cancer Surgery.…”

“…3 Comparisons of CoC accredited and non-CoC accredited institutions have been previously reported, but these studies have largely focused on overall survival outcomes. [4][5][6] Although the 2020 Standards currently mandates synoptic documentation of essential elements from the CoC's 2015 publication of Operative Standards for Cancer Surgery, there is a lack of research examining operative report compliance with Operative Standards. To determine baseline compliance with operative standards suggested in 2015 and mandated in January, 2020, we sought to compare the operative report documentation of the essential steps and technical surgical outcomes, such as lymph node (LN) yield, and re-excision rates, for Volume 1 cancer operations (lung, colon, pancreas, and breast) between a CoC accredited and a non-CoC accredited institution.…”

CD200 promotes immunosuppression in the pancreatic tumor microenvironment

“…Pathology was assessed in H&E stained slides to determine the differentiation state of tissue as pancreatic intraepithelial neoplasia (PanIN)−1, PanIN-2, PanIN-3, or PDAC. For studies using MT5 tumor cells, 1×10 6 cells were injected subcutaneously in the flank of C57BL/6 mice and injected intraperitoneally three times each week with 200 µg/mouse of isotype, anti-CD200 and/or anti-PD-1 Ab (BioXCell) treatment starting once tumors reached 50-100 mm 3 volume. single-cell rnA sequencing using chromium 10× genomics platform Cryopreserved whole PBMC from PDAC patients (n=4) were thawed, washed, and counted.…”

“…Pancreatic cancer is currently the third leading cause of cancer death and due to a lack of early clinical signs, over 55% of patients present with advanced metastatic disease by the time of diagnosis. [1][2][3][4] The prognosis for patients with metastatic disease remains poor, with a 5-year survival rate of only 3% and median survival time of 3-6 months. 1 5 Published models predict that pancreatic ductal adenocarcinoma (PDAC) will surpass colon cancer, becoming the second leading cause of cancer-related deaths by the year 2030.…”