Factors Associated with Improved Survival for Stage I and II Pancreatic Adenocarcinoma Utilizing the National Cancer Database.

Abstract

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer related death in the United States. While Stage I and II PDAC represent the most treatable and potentially curative stages, most patients do not survive past 5 years of treatment. We sought to understand factors associated with long term survival in early-stage PDAC to improve outcomes and reduce disparities.

Methods: The National Cancer Database (NCDB) was queried for Stage I and II PDAC patients treated between 2012 and 2021. Patients were only included if they had a documented survival information. Comparisons between patients alive or deceased at 1, 3 and 5 years were evaluated using Wilcoxon, Chi-square, and Cochran-Armitage trend tests where appropriate. A multivariable Cox proportional hazards model (MVA) was used to evaluate factors associated with overall survival (OS).

Results: We analyzed 43,398 patients with Stage I (n = 21,938) and Stage II (n = 21,460) PDAC. One-, three-, and five-year survival rates were 75.2%, 30.3%, and 12.8% for Stage I, and 68.6%, 23.4%, and 10.5% for Stage II, respectively. Across both stages, improved survival was significantly associated with younger age, lower Charlson-Deyo comorbidity score, Asian race, private insurance, higher income and education levels, and tumor location in the pancreatic body or tail (all p < 0.0001). Higher tumor grade, Black race, Medicaid or uninsured status, and treatment at community-level facilities were associated with significantly worse outcomes. Multivariable analysis confirmed these variables as independent predictors of one-, three-, and five-year survival. Despite early-stage diagnosis, marked disparities in long-term survival persisted based on race, insurance, and socioeconomic status.

Conclusion: Long-term survival for Stage I and II PDAC remains limited, despite diagnosis at an early and potentially curative stage. This highlights the need to not only focus on screening mechanisms for early diagnosis, but to address disparities and expand access to high-quality care that limit long term survival in this cohort. These results support ongoing investment in early detection, equitable treatment delivery, and research into tailored therapeutic strategies.