Geographic region is associated with treatment and survival outcomes for pancreatic cancer

Abstract

Objective: We sought to assess the impact of geographic region on treatment characteristics and survival for pancreatic adenocarcinoma. Methods: The SEER registry was used to identify patients with potentially resectable pancreatic adenocarcinoma (AJCC I–III) diagnosed between 2004 and 2013. The exposure of interest was geographic region of diagnosis: West (WE), South (SO) or North-East (NE). The endpoints of interest were: (1) recommendation of no surgery by the provider (2) utilization of resection and (3) disease-specific mortality. Multivariable Logistic and Cox regression models were used to determine associations. Results: Overall, 12,485 patients were identified [NE – 23.4%, SO – 36.1% and WE – 40.5%]. On univariate analysis, the likelihood of a recommendation of no surgery was lowest in the NE (OR: NE – 0.6, SO – 0.7, WE – Ref; P<0.05 for all). This association persisted following risk adjustment (OR: NE – 0.5, SO – 0.8, WE – Ref; P<0.05 for all). Compared to other regions, patients diagnosed in the NE were independently more likely to undergo resection (OR: NE – 2.1, SO – 1.2, WE – Ref; P<0.05 for all). Furthermore, diagnosis in the NE was an independent predictor of survival (Table 1). Among patients that underwent resection, diagnosis in the SO was independently associated with an increased risk of mortality (HR: 1.2; P<0.001). Conclusion: Significant disparities in treatment and survival outcomes for pancreatic cancer exist on the basis of geographic region. Improved adherence to guideline-driven treatment recommendations, standardization of care processes, and regionalization may help stem the existing variability in care and outcomes.Table 1Risk-adjusted association between geographic region and mortality stratified by tumor stage.Geographic regionHazard ratio*95% Confidence intervalP-valueOverall WestRef South1.191.13-1.26<0.001 North East0.940.88-0.990.044AJCC I WestRef South1.130.98-1.300.083 North East1.110.93-1.320.241AJCC II WestRef South1.211.13-1.30<0.001 North East0.970.90-1.040.422AJCC III WestRef South1.151.03-1.280.013 North East0.850.76-0.950.004 Open table in a new tab