49 National Trends in Liver and Pancreatic Malignancy in the U.S.: Increasing Interventions yet Mortality Persists

Abstract

INTRODUCTION: Although there have been recent advances in the treatment of liver and pancreatic cancer, the incidence of both has continued to rise in the USA as well as worldwide. Our aim was to analyze the most recent trends in hospital admissions for malignant liver and pancreas neoplasms and the associated interventions, as well as in-hospital mortality in the US using the largest administrative database, the National Inpatient Sample (NIS). METHODS: We extracted admission data of patients of all ages (0–70+) from 2006 to 2014 with associated primary ICD-9 diagnosis codes of liver (155.0) and pancreatic neoplasms (157), and queried for associated procedures (total/local excision/destruction, transplantation, Whipple procedure). Survey data analysis methods were used for national estimates and trend analysis. RESULTS: National estimates of admissions due to liver cancer continued to rise from 29,388 in 2006 to 54,930 in 2014. Pancreatic cancer related admissions have also been increasing from 71,479 in 2006 to 95,145 in 2014 (Figure 1). The majority of liver and pancreatic cancers manifested in patients over the age of 50 (92.5%), with the highest number of hospitalizations occuring in patients above age 70 (38%, Table 1). There were more males than females who were admitted due to liver or pancreatic cancer (59% vs. 41%), and most patients were White (67%), followed by Black (14%), Hispanic (11%), Asian/Pacific Islander (4.4%) and Native American/other (3.5%). Despite increasing numbers of cancer related hospitalizations, in-hospital mortality has been decreasing from 11% to 8% in the same 9 year period. Liver transplantation has tripled (650 in 2006 to 1940 in 2014), and the number of loco-regional interventions on liver cancer as well as partial pancreatectomy and Whipple procedures have together all increased at greater rates than hospitalizations for each malignancy (Table 1). CONCLUSION: Liver and pancreatic cancer related hospitalizations in the USA has risen for the last decade, and so has the intent-to-cure procedures for these malignancies. The curative liver transplant and Whipple procedure have almost tripled and doubled in number, respectively. However, in-patient mortality from both liver and pancreatic cancer has decreased only by 3% in the past decade and mortality rates remain at 8%. Future strategies to optimize liver and pancreatic cancer screening and medical/surgical treatment is urgently needed in order to decrease liver and pancreatic cancer related admissions and mortality.