Su1032 IMPROVED SURVIVAL IN EUS GUIDED FNA COMPARED TO PERCUTANEOUS ASPIRATION IN PANCREATIC CANCER: A PROPENSITY SCORE ANALYSIS

Abstract

Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) is recognized as an effective and safe means of obtaining tissue to diagnosis pancreatic cancer. Previous studies have shown no mortality difference in patients undergoing EUS-FNA despite the initial concern that its use would lead to increased tumor dissemination. However, studies have not assessed if this held true when compared to percutaneous aspiration, as both methods could lead to tumor seeding along the needle track. We aimed to investigate if EUS-FNA conferred any mortality benefit compared to percutaneous aspiration. The Surveillance, Epidemiology and End Results (SEER)- Medicare linked database was used to identify patients >65 years diagnosed with pancreatic cancer between 2000-2011. We identified patients who underwent EUS-FNA or percutaneous aspiration within three months of cancer diagnosis as well as chemotherapy, radiation, and surgery from claims data. Demographic and clinical characteristics were compared using chi-squared tests. Kaplan Meier methods and inverse propensity-weighted adjusted Cox proportional hazard ratios (aHR) were used to evaluate survival. Between 2000-2011, 32,510 patients were diagnosed with pancreatic cancer. 4,137 underwent EUS-FNA (38.61%) compared with 6,578 who underwent percutaneous biopsy (61.39%). 1,786 (14.29%) underwent both EUS-FNA and percutaneous biopsy within 3 months of cancer diagnosis and were excluded. Mean survival (standard deviation) for patients who received EUS-FNA was 9.71 months (+/- 11.65), compared with 6.7 months (+/- 11.10) for those who underwent percutaneous biopsy (p<0.0001). After adjusting for confounders, patients who received EUS-FNA had improved survival (aHR 0.72, 95%CI 0.70-0.75). In stratified analysis, improved survival with EUS-FNA was seen for patients with localized disease (aHR 0.71, 95% CI 0.66-0.78), regional disease (aHR 0.77, 95% CI 0.74-0.80), and distant disease (aHR 0.69, 95% CI 0.66-0.73). When limited to patients who underwent surgery and adjusted for confounders, patients who received EUS-FNA continued to have improved survival (aHR 0.66, 95%CI 0.60-0.72). Improved pancreatic cancer survival was seen in patients who underwent EUS-FNA compared with those who underwent percutaneous aspiration. This survival advantage was seen for all stages of disease. Given that EUS-FNA may not be widely available, its use may be a surrogate for patients having had access to care at an expert center, which may thus lead to improvement in survival.View Large Image Figure ViewerDownload Hi-res image Download (PPT)