Abstract
Introduction: With the advent of endoscopic ultrasound, tissue sampling of suspicious pancreatic lesions is more routinely performed via endoscopic ultrasound guided fine needle aspiration (EUS-FNA) compared to percutaneous aspiration. Studies have not investigated whether either technique is associated with a mortality benefit, as both methods could lead to tumor seeding along the needle track. Methods: We identified patients >65 years who were diagnosed with pancreatic cancer between 2007-2015 using The Surveillance, Epidemiology and End RESULTS (SEER)- Medicare linked database. Patients who underwent EUS-FNA or percutaneous aspiration within three months of cancer diagnosis were included and patients who underwent both procedures were excluded. Survival was calculated using Kaplan Meier methods and inverse propensity-weighted adjusted Cox proportional hazard ratios (aHR), adjusted for clinical and demographic variables as well as chemotherapy, radiation, and surgery. Results: Between 2000-2015, 6,093 patients underwent EUS-FNA (44.8%) compared with 7,513 who underwent percutaneous biopsy (55.2%). Median survival (Q1-Q3) for patients who received EUS-FNA was 6.0 months (2.0-13.0) compared with 4.0 months (1.0-9.0) for those who underwent percutaneous biopsy (p < 0.0001). After adjusting for confounders, patients who received EUS-FNA had improved survival (aHR 0.81, 95%CI 0.79-0.84). In stratified analysis, improved survival with EUS-FNA was seen for patients with localized disease (aHR 0.78, 95% CI 0.72-0.84), regional disease (aHR 0.89, 95% CI 0.85-0.93), and distant disease (aHR 0.79, 95% CI 0.76-0.82). When limited to patients who underwent surgery and adjusted for confounders, there was no difference in survival between groups (aHR 0.92, 95%CI 0.83-1.00). Conclusion: Patients with pancreatic cancer who underwent EUS-FNA survived longer compared with those who underwent percutaneous aspiration, though no difference was seen when limited to patients who underwent surgery. Providers should be reassured that EUS-FNA can be used to safely diagnose pancreatic cancer. EUS-FNA may also serve as a surrogate for expert care, which may have led to improvement in survival.
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