Ahmed Messallam, MD1, Ambreen A. Merchant, MBBS2, Saurabh Chawla, MD, FACG3, Vaishali Patel, MD, MHS1, Steven Keilin, MD4, Qiang Cai, MD, PhD, FACG1, Field Willingham, MD, MPH1; 1Emory University, Atlanta, GA; 2Emory University, Decatur, GA; 3Emory Health Care, Atlanta, GA; 4Emory University Hospital, Atlanta, GA
Introduction: Pancreatic cancer is associated with decreased survival, with a 5-year survival rate less than 40% for localized stages. Surgical resection is the mainstay of potentially curative therapy. However, not all patients with tumors eligible for surgery undergo surgical intervention. We aimed to identify the proportion of patients with pancreatic cancer who may benefit from non-surgical, local ablative interventions. Methods: Data was extracted from the Surveillance, Epidemiology and End Results (SEER) database. Adult patients with pancreatic malignant tumors, registered in the years 2004-2017 were included. Patients were excluded if they had no microscopic confirmation, distant disease (SEER Summary stage), or unknown TNM classification or unknown tumor size. Results: A total of 24,594 patients met inclusion and exclusion criteria. Age bracket 50-85 constituted 86% of the cohort with 50.3% being female. The racial distribution was: 80.8% white, 10.9% black and 7.6% Asian. Tumor size was ≤ 2cm in 14.5%; 2-4cm in 47.7% and ≥ 4 cm in 37.8%. T stage was: T1 7.9%, T2 21.7%, T3 13,170 53.5% and T4 16.8% (Table 1). With regards to surgical treatment, surgery was not recommended or contraindicated in 11,768 (47.8%) of the cohort, surgery was recommended but not performed in 855 (3.5%) and surgery was performed in 11,971 (48.7%). For those whom surgery was recommended but not performed, this group had a higher proportion of patients that were age >85, black race, from less populated areas (< 250,000) and tumor size (2-4cm). Reasons for not performing recommended surgery included patient’s refusal in 45.4%, patient’s death prior to surgery in 7% and unknown reasons in 47.6% (Table 2) Discussion: Excluding patients with metastatic disease, 51.3% of patients with pancreatic cancer are not eligible for or offered resection. Of those offered resection, 6.7% do not receive the recommended surgery. There is a large unmet need for local ablative therapy for pancreatic cancer.
Patient and tumor characteristics of the included cohort
Comparison between patients who had pancreatic surgery versus those in whom surgery was recommended but not performed.
Disclosures: Ahmed Messallam indicated no relevant financial relationships. Ambreen Merchant indicated no relevant financial relationships. Saurabh Chawla indicated no relevant financial relationships. Vaishali Patel indicated no relevant financial relationships. Steven Keilin indicated no relevant financial relationships. Qiang Cai: Boston Scientific – Consultant. Field Willingham: Boston Scientific – Grant/Research Support. Cancer Prevention Pharmaceuticals – Grant/Research Support. Cook Medical – Grant/Research Support. Oncolys Biopharma – Consultant. RedPath – Grant/Research Support. Xlumena – Grant/Research Support.