The Lynx Group

Adjuvant Therapy at High-Volume Centers Improves Pancreatic Cancer Survival

April 2016, Vol 7, No 3

The advantages of treatment at a high-volume center extended to adjuvant therapy in patients with resected pancreatic cancer, according to a study reported by Margaret T. Mandelson, PhD, MPH, Floyd and Dolores Jones Cancer Institute, Virginia Mason Medical Center, Seattle, WA, at the 2016 Gastrointestinal Cancers Symposium.

The median overall survival (OS) and 5-year OS rates improved by more than 50% in absolute terms among patients who received adjuvant therapy at a high-volume facility. The survival hazard declined by 37%.

Although the retrospective study had a number of limitations, the data still made a strong case for patients to receive adjuvant therapy in addition to their surgery at an experienced center that cares for a large volume of patients with pancreatic cancer, said Dr Mandelson.

“The high-volume and community-­center patients differed only with respect to age among the patient characteristics assessed,” she said. “Our study lends support to the use of high-volume centers for all therapy components for pancreatic cancer treated with curative intent. Ongoing investigation of patterns of care and their impact on overall survival in pancreatic cancer is warranted.”

Surgical resection continues to offer the best odds for long-term survival in patients with localized pancreatic cancer. Multiple studies have yielded “strong and consistent evidence” of a volume–outcome relationship for resected pancreatic cancer, said Dr Mandelson.

Although it is a less dominant prognostic factor than surgery, adjuvant therapy also contributes to the overall potential for long-term survival in patients with pancreatic cancer. Whether a similar volume–outcome association exists for adjuvant therapy has remained unclear.

Dr Mandelson and colleagues reviewed the medical records of patients who underwent surgery for pancreatic cancer at Virginia Mason from 2003 to 2004.

Approximately 300 patients receive treatment annually for newly diagnosed pancreatic cancer as well as up to 100 patients with recurrent disease.

Eligible patients underwent primary surgical resection at Virginia Mason, and had the intention to receive adjuvant therapy at Virginia Mason or were referred to a medical oncologist. The data analysis comprised 245 patients, 139 of whom received treatment at Virginia Mason and 106 of whom received treatment in the community. The patients receiving treatment in the community were older (68.2 years vs 63.1 years; P <.01), but they did not differ from those receiving treatment at Virginia Mason with respect to sex distribution, socioeconomic factors, performance status, or disease characteristics.

Of the 139 patients who received treatment at Virginia Mason, 96% started chemotherapy, 81% received multiagent chemotherapy, and 53% received chemoradiation. The characteristics of treatment in the community were unavailable.

The data showed a “striking” difference in median OS. The patients who received treatment at the high-volume center had a median OS of 43.6 months compared with 27.9 months for patients who received treatment in the community. The 5-year OS was 38.6% for the high-volume cohort and 24.8% for the community cohort.

Dr Mandelson acknowledged that multiple factors can influence survival, including patient-specific factors, paraneoplastic factors, tumor characteristics, type and completeness of therapy, and supportive care. These results may help inform decision-making about care for patients with pancreatic cancer.

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