Selection, therapy, and outcome in an unselected population-based study of 604 patients with pancreatic cancer.

Abstract

238 Background: Knowledge of patients (pts) with pancreatic cancer (PC) is often inferred from randomized phase III trials or registry based studies. Information about selection, therapy, and outcome is however often limited by availability of data in registries or lack of generalizability due to strict inclusion criteria in phase III studies. We wanted to investigate therapy choices and survival in a complete population of pts with PC. Methods: During 2007-2009 all cases of PC in the Region of Southern Denmark (RSD) (pop: 1,200,000) was retrieved from the Danish Cancer Registry. Concurrently we established a registry at the regional PC cancer center, recording clinical variables. The two registries were merged and dis-concordant cases were all examined. Information about hematology, liver function, performance status and therapy was retrieved from patient charts. Patients with neuroendocrine or acinar cell carcinomas were excluded from outcome analysis. Results: 618 cases of PC were retrieved from the Danish Cancer Registry. After examining dis-concordant pairs and histology 64 cases were removed and 25 added resulting in a total of 579 eligible pts with PC. Based on therapy delivered pts were divided in four groups (Table 1). Sixty-five pts had an initial resection of their tumor, 191 pts were treated with either chemotherapy or chemo-radiotherapy (CT/CRT), 56 pts were evaluated for CT/CRT, but was in too poor performance status or progressed/died before therapy; finally 268 pts were never evaluated for CT/CRT and never received tumor directed therapy. Of the total population 3% participated in clinical trials. Conclusions: Survival of un-selected patients appears to be similar to trial patients, and has improved compared to other registry based studies. However the majority of pts with PC do not receive cancer directed therapy. Improving the outcome of PC pts as a whole requires research into the large group of untreated pts. [Table: see text]