Scaife Hall, Pittsburgh, 15261, USA.
Ann Surg Oncol. 2018 Jul;25(7):1860-1867. doi: 10.1245/s10434-018-6487-5. Epub 2018 Apr 24.
National adherence to treatment guidelines for pancreatic ductal adenocarcinoma (PDAC) is a concern. This study aims to evaluate national expected treatment (ET) adherence for all PDAC stages. We hypothesized that both patient and hospital demographics are associated with national ET disparities for PDAC.
Clinical stage I through IV PDAC patients were evaluated using the National Cancer Data Base from 2004 to 2013. ET was defined as surgery for stage I/II, chemotherapy or radiation for stage III, and chemotherapy for stage IV. Unexpected treatment (UT) was defined as no surgery for stage I/II, surgery for stage III, and radiation or surgery for stage IV. No treatment is denoted by NT.
171,351 patients were identified, of whom 56,589 (33.0%) were stage I/II, 23,459 (13.7%) were stage III, and 91,303 (53.3%) were stage IV. Of patients, 48.4% received ET, 14.7% received UT, and 36.9% received NT. ET rates were 41.1% for stage I/II, 65.4% for stage III, and 48.5% for stage IV patients. On multivariable analysis, older age, non-White race, lower socioeconomic status, being uninsured or Medicaid, increased comorbidities, nonacademic centers, and low-volume hospitals were independent negative predictors of receiving ET (P < 0.01). On subgroup analysis, high-volume academic centers had similar negative predictors of ET despite higher ET adherence overall (P < 0.01).
Patient and hospital factors impact ET of PDAC on a national level. These treatment disparities for PDAC are concerning, even at high-volume academic centers. Future studies need to identify the causes of treatment disparities for PDAC with intervention measures aimed to relieve treatment disparities.
国家对胰腺导管腺癌（PDAC）治疗指南的依从性令人担忧。本研究旨在评估所有 PDAC 分期的国家预期治疗（ET）依从性。我们假设患者和医院的人口统计学特征与 PDAC 的国家 ET 差异有关。
使用国家癌症数据库，从 2004 年至 2013 年评估了临床分期 I 至 IV 期 PDAC 患者。ET 定义为 I/II 期手术，III 期化疗或放疗，IV 期化疗。意外治疗（UT）定义为 I/II 期无手术，III 期手术，IV 期放疗或手术。无治疗（NT）表示未进行任何治疗。
共纳入 171351 例患者，其中 56589 例（33.0%）为 I/II 期，23459 例（13.7%）为 III 期，91303 例（53.3%）为 IV 期。48.4%的患者接受了 ET，14.7%接受了 UT，36.9%接受了 NT。I/II 期 ET 率为 41.1%，III 期为 65.4%，IV 期为 48.5%。多变量分析显示，年龄较大、非白种人、社会经济地位较低、无保险或医疗补助、合并症增多、非学术中心和低容量医院是接受 ET 的独立负预测因素（P<0.01）。亚组分析显示，尽管高容量学术中心的 ET 依从性较高，但仍存在 ET 的负预测因素（P<0.01）。
患者和医院因素对 PDAC 的国家 ET 有影响。即使在高容量学术中心，PDAC 的这种治疗差异也令人担忧。未来的研究需要确定 PDAC 治疗差异的原因，并采取干预措施来缓解治疗差异。
