Department of Surgery, The University of South Alabama, 2451 USA Medical Center Drive, Mastin, 705, Mobile, AL, 36617, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Gastrointest Surg. 2023 Oct;27(10):2155-2165. doi: 10.1007/s11605-023-05764-z. Epub 2023 Aug 8.
Pancreatic adenocarcinoma (PDAC) is an aggressive malignancy associated with poor outcomes. Surgical resection and receipt of multimodal therapy have been shown to improve outcomes in patients with potentially resectable PDAC; however treatment and outcome disparities persist on many fronts. The aim of this study was to analyze the relationship between rural residence and receipt of quality cancer care in patients diagnosed with non-metastatic PDAC.
Using the National Cancer Database, patients with non-metastatic pancreatic cancer were identified from 2006-2016. Patients were classified as living in metropolitan, urban, or rural areas. Multivariable logistic regression was used to identify predictors of cancer treatment and survival.
A total of 41,786 patients were identified: 81.6% metropolitan, 16.2% urban, and 2.2% rural. Rural residing patients were less likely to receive curative-intent surgery (p = 0.037) and multimodal therapy (p < 0.001) compared to their metropolitan and urban counterparts. On logistic regression analysis, rural residence was independently associated with decreased surgical resection [OR 0.82; CI 95% 0.69-0.99; p = 0.039] and multimodal therapy [OR 0.70; CI 95% 0.38-0.97; p = 0.047]. Rural residence independently predicted decreased overall survival [OR 1.64; CI 95% 1.45-1.93; p < 0.001] for all patients that were analyzed. In the cohort of patients who underwent surgical resection, rural residence did not independently predict overall survival [OR 0.97; CI 95% 0.85-1.11; p = 0.652].
Rural residence impacts receipt of optimal cancer care in patients with non-metastatic PDAC but does not predict overall survival in patients who receive curative-intent treatment.
胰腺导管腺癌（PDAC）是一种侵袭性恶性肿瘤，预后不良。手术切除和接受多模式治疗已被证明可改善潜在可切除 PDAC 患者的预后；然而，在许多方面仍然存在治疗和结果的差异。本研究旨在分析农村居民与接受非转移性 PDAC 患者的优质癌症治疗之间的关系。
使用国家癌症数据库，从 2006 年至 2016 年确定患有非转移性胰腺癌的患者。将患者分为居住在大都市区、城市或农村地区。使用多变量逻辑回归来确定癌症治疗和生存的预测因素。
共确定了 41786 名患者：81.6%为大都市区，16.2%为城市，2.2%为农村。与大都市区和城市患者相比，农村居民接受根治性手术（p=0.037）和多模式治疗（p<0.001）的可能性较低。在逻辑回归分析中，农村居民与手术切除率降低独立相关[OR 0.82；95%CI 0.69-0.99；p=0.039]和多模式治疗[OR 0.70；95%CI 0.38-0.97；p=0.047]。农村居民独立预测所有接受分析的患者的总生存率降低[OR 1.64；95%CI 1.45-1.93；p<0.001]。在接受手术切除的患者队列中，农村居民与总生存率降低无关[OR 0.97；95%CI 0.85-1.11；p=0.652]。
农村居民影响非转移性 PDAC 患者接受最佳癌症治疗，但不能预测接受根治性治疗的患者的总生存率。
