Undertreatment of Pancreatic Cancer: Role of Surgical Pathology
Open Access
- Author:
- Olecki, Elizabeth
- Graduate Program:
- Clinical Research
- Degree:
- Master of Science
- Document Type:
- Master Thesis
- Date of Defense:
- March 19, 2021
- Committee Members:
- Chan Shen, Thesis Advisor/Co-Advisor
Li Wang, Committee Member
Christopher Hollenbeak, Committee Member - Keywords:
- Pancreatic Cancer
Undertreatment
Disparity
National Cancer Database
Pathology - Abstract:
- Background: Current guidelines recommend treatment of early stage pancreatic cancer with surgical resection and chemotherapy. Undertreatment can occur after resection when patients fail to receive adjuvant chemotherapy. Pathologic results have the potential to bias providers to omit adjuvant chemotherapy. Methods: Data obtained from the National Cancer Database were used to identify patients who underwent surgery for stage I/II pancreatic cancer. Chi-square and multivariable logistic regression were used to determine differences between patients receiving surgery and chemotherapy versus resection only. Survival analysis was performed in each favorable subgroup (node negative disease, tumor size <=2cm, and well-differentiated histology) by Kaplan Meier method and Cox proportional hazards model. Results: Of the 22,131 patients included in this study, 28.0% were considered undertreated (surgery only). Favorable pathologic traits of negative lymph nodes, tumor size <=2cm, and well-differentiated histology were associated with a decreased odds of receiving adjuvant chemotherapy compared to less favorable pathologic results (OR 0.65-0.85, p<0.001). Multivariable survival analysis revealed significantly lower mortality in patients who received resection and chemotherapy compared to those who were undertreated among two subgroups: node negative disease (HR 0.774) and tumor size <=2cm (HR 0.771). Conclusion: This study found that early stage pancreatic cancer patients with favorable pathology after pancreatectomy were less likely than those with unfavorable pathology to receive adjuvant chemotherapy and that this has significant survival consequences for subgroups with node negative disease and tumors <=2cm. Recognition of those with favorable pathology as an undertreated group is required to direct efforts to encourage guideline concordant care and combat undertreatment of pancreatic cancer.