Missed Opportunities for Multimodality Therapy in Resectable Pancreatic Cancer: National Disparities and Consequences for Survival.

IF 1.9 3区医学 Q3 ONCOLOGY

Journal of Surgical Oncology Pub Date : 2026-09-27 DOI:10.1002/jso.70408

John Johnson, Derek Erstad, Jose Euberto Mendez Reyes, Eric Silberfein, George Van Buren, William Fisher, E Ramsay Camp

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引用次数: 0

Abstract

Background: Multimodal therapy (MMT) combining surgery and chemotherapy remains the optimal management strategy irrespective of sequence for resectable pancreatic ductal adenocarcinoma (PDAC). Determinants of MMT receipt and sequencing remain incompletely understood, particularly regarding neoadjuvant strategies. We aimed to identify modifiable characteristics contributing to differences in MMT receipt and sequencing in the surgical PDAC population.

Methods: Using the 2023 National Cancer Database, we analyzed 11 202 adults with non-metastatic resectable PDAC (2010-2020). Patients were grouped into four treatment categories: surgery only, neoadjuvant chemotherapy plus surgery, adjuvant chemotherapy plus surgery, and combined neoadjuvant plus adjuvant chemotherapy with surgery. Outcomes included 5-year overall survival and multivariable logistic regression for chemotherapy receipt.

Results: Of 11 202 patients, 3605 (32.2%) underwent surgery alone, 6347 (56.7%) received adjuvant chemotherapy, 626 (5.6%) neoadjuvant chemotherapy, and 624 (5.6%) both. Surgery-only patients were older, Medicare-insured, and treated at community, low-volume centers, while MMT patients were younger and privately insured (p < 0.001). Five-year survival was highest with combined neoadjuvant and adjuvant therapy (31.9%). Older age, Medicaid insurance, community centers, low/intermediate-volume facilities, and higher comorbidity burden were associated with reduced odds of MMT receipt (p < 0.05).

Conclusion: Disparities continue to exist for MMT in the PDAC surgical population, highlighting opportunities for improved patient education and enhanced multidisciplinary care.

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可切除胰腺癌多模式治疗的错失机会：国家差异和生存后果。

背景：手术和化疗相结合的多模式治疗（MMT）仍然是可切除胰腺导管腺癌（PDAC）的最佳治疗策略，无论其治疗顺序如何。MMT接受和排序的决定因素仍然不完全清楚，特别是关于新辅助策略。我们的目的是确定导致手术PDAC人群中MMT接收和测序差异的可改变特征。方法：使用2023年国家癌症数据库，我们分析了11202例非转移性可切除PDAC成人（2010-2020）。将患者分为单纯手术、新辅助化疗+手术、辅助化疗+手术、新辅助化疗+辅助化疗+手术四种治疗方式。结果包括5年总生存率和化疗接受情况的多变量logistic回归。结果：11202例患者中，单纯手术3605例（32.2%），辅助化疗6347例（56.7%），新辅助化疗626例（5.6%），联合化疗624例（5.6%）。仅接受手术的患者年龄较大，有医疗保险，在社区小容量中心接受治疗，而MMT患者年龄较小，有私人保险(p结论：PDAC手术人群中MMT的差异仍然存在，突出了改善患者教育和加强多学科护理的机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Oncology 医学-外科

CiteScore

4.70

自引率

4.00%

发文量

367

审稿时长

2 months

期刊介绍： The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.