Department of Surgery, Division of Surgical Oncology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA.
Department of Public Health, East Carolina University, Greenville, North Carolina, USA.
J Surg Oncol. 2022 Sep;126(4):698-707. doi: 10.1002/jso.26984. Epub 2022 Jun 14.
For pancreatic ductal adenocarcinoma (PDAC) which lacks a recommended screening modality, the benefit of the Affordable Care Act (ACA) may not be an earlier diagnosis, but rather improved rates of treatment. The objective of this study was to examine change in the stage of PDAC presentation and treatment disparities following the ACA.
A retrospective cohort study of patients with primary PDAC identified in the 2004-2017 National Cancer Database was divided into pre- and post-ACA, for which the primary outcomes of a stage of presentation, receipt of surgical resection, and systemic therapy (termed multimodality) (Stage I-II), and receipt of systemic therapy (Stage III-IV) were compared by multivariable analysis.
228,015 patients were included. Odds of presenting with Stage I-II PDAC were significantly higher in 2011-2017 versus 2004-2010 (odds ratio 1.44, 95% confidence interval 1.40-1.47). Black patients with early-stage disease had a lower likelihood of multimodality therapy and those with advanced disease were less likely to receive systemic therapy, before and after the ACA. Uninsured patients were less likely to receive any therapy compared with insured patients; this disparity increased in the post-ACA period.
An earlier presentation of PDAC increased following the ACA. However, racial, insurance, and socioeconomic treatment disparities persist.
对于缺乏推荐筛查方法的胰腺导管腺癌 (PDAC)，《平价医疗法案》 (ACA) 的好处可能不是更早的诊断，而是提高治疗率。本研究的目的是研究 ACA 后 PDAC 表现和治疗差异的阶段变化。
对 2004-2017 年国家癌症数据库中确定的原发性 PDAC 患者进行回顾性队列研究，分为 ACA 前后两个时期，主要结局为表现阶段、接受手术切除和系统治疗（称为多模式治疗）（I 期-II 期）和接受系统治疗（III 期-IV 期），通过多变量分析进行比较。
共纳入 228,015 例患者。与 2004-2010 年相比，2011-2017 年 I 期-II 期 PDAC 的发病几率显著升高（比值比 1.44，95%置信区间 1.40-1.47）。患有早期疾病的黑人患者接受多模式治疗的可能性较低，而患有晚期疾病的患者在 ACA 前后接受系统治疗的可能性较低。与有保险的患者相比，未参保的患者接受任何治疗的可能性较低；这种差异在 ACA 后时期增加。
ACA 后 PDAC 的表现较早。然而，种族、保险和社会经济治疗差异仍然存在。
