P0095 (S0101). - Clinical and Demographic Predictors of Rapidly Progressive Disease in Patients Undergoing Surgery for Pancreatic Ductal Adenocarcinoma: Risk Profiling From the National Cancer Database
Medical Student Yale New Haven Hospital New Haven, CT
Ysabel Ilagan-Ying, MD1, Lee Ying, MD, PhD1, Leah M. Ferrucci, PhD, MPH2, Nicholas Peters, MD, MA1, Holly Blackburn, MD1, John Kunstman, MD, MHS3, Nita Ahuja, MD, MBA4; 1Yale New Haven Hospital, New Haven, CT; 2Yale School of Public Health, New Haven, CT; 3Yale School of Medicine, New Haven, CT; 4Yale School of Medicine, Yale New Haven Hospital, Yale Cancer Center, New Haven, CT
Introduction: Pancreatic cancer is the third most common cause of cancer-related mortality and survival times after surgery vary widely. There are limited studies that have evaluated clinical and demographic predictors of patients who survive less than one year following surgery. Methods: We queried 380,524 participants diagnosed with pancreatic cancer between 2004-2016 from the National Cancer Data Base (NCDB) Participant User Files. We identified 51,345 patients with histologically-confirmed pancreatic adenocarcinoma and reported postoperative survival times. Patients were categorized into with rapidly progressive (RP) disease (3 months – 1 year survival, n=16,234) and those with non-rapidly progressive(nRP) disease ( >1 year survival, n=35,111). We conducted descriptive analysis and calculated risk using Cox regression models. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed after adjusting for patient, tumor, hospitalization, and treatment characteristics to assess for characteristics associated with RP compared with nRP. Results: The median age of the NCDB cohort was 66 years, with a median survival time of 0.64 years (IQR: 0.45, 0.81) for the RP group compared to 2.16 years (IQR: 1.48, 3.55) for the nRP group. Notably, 56.6% were > 65 years old, 13.1% were non-white, and 52.5% were on Medicare insurance. Several clinical and demographic characteristics were independent predictors of having RP versus NRP disease (Table 1). Patients with RP disease are more likely to have longer hospital stays, unplanned 30-day readmission, and worse tumor characteristics at time of surgery. Additionally, those lower income, as well as those with Medicaid and Medicare insurance were at higher risk for RP disease. Additionally, patients with a higher comorbidity score, tumor stage and grade, lymph node involvement, and positive tumor margins were at greater risk of RP. Discussion: Pancreatic adenocarcinoma is highly lethal, and though surgery is reserved for patients without locally advanced disease, survival times after definitive treatment vary widely. More is needed to understand the demographic and clinical difference between RP and nRP disease so that follow-up care can potentially target those with higher risk demographics, more complicated hospital courses, and worse tumor characteristics.
Table 1. Multivariate Analysis for Predictors of Rapidly Progressive Disease (RP) Risk Among 51,345 NCDB Pancreatic Adenocarcinoma Surgical Patients with Reported Survival Times >90 Days from Surgery Date
Disclosures: Ysabel Ilagan-Ying indicated no relevant financial relationships. Lee Ying indicated no relevant financial relationships. Leah Ferrucci indicated no relevant financial relationships. Nicholas Peters indicated no relevant financial relationships. Holly Blackburn indicated no relevant financial relationships. John Kunstman indicated no relevant financial relationships. Nita Ahuja indicated no relevant financial relationships.