Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610, USA.
Department of Biostatistics, University of Florida College of Public Health and Health Professions & College of Medicine, Gainesville, FL, USA.
J Gastrointest Surg. 2023 Nov;27(11):2474-2483. doi: 10.1007/s11605-022-05531-6. Epub 2023 Sep 22.
Biopsy of suspected pancreatic cancer (PDAC) in surgical candidates is informative however not always necessary. Biopsies impact treatment options as histological diagnosis are presently required for neo-adjuvant therapy, but not surgical resection. We explored the impact of pursuing tissue diagnosis by endoscopic ultrasound (EUS) biopsy on time to treatment in patients with resectable and borderline resectable PDAC.
A retrospective review of surgical patients with ultimately proven PDAC was performed (2011-2021). Milestone dates (cancer suspected, biopsy(ies), surgical or neo-adjuvant treatment) were collected. Mann-Whitney-Wilcoxon tests, Pearson's chi-squared tests, Fisher's exact tests, linear regressions, and Cox proportional hazard models were used for data analysis.
Among 131 resectable and 58 borderline resectable patients, the borderline resectable group underwent more biopsies (1.2 vs 0.7, p < 0.0001), were more likely to undergo biopsy at tertiary care centers (67.2% vs 30.5%, p < 0.0001), and trended toward longer time to treatment (49 vs 44 days, p = 0.070). Significant increases in days to treatment were seen in patients with Black race (29 days, p = 0.0002) and Medicare insurance (22 days, p = 0.038) and no biopsies at a tertiary care center (10 days, p = 0.039). After adjusting for covariates, additional biopsies significantly delayed treatment (1 biopsy: 21 days, p = 0.0001; 2 biopsies: 44 days, p < 0.0001; 3 biopsies: 68 days, p < 0.0001).
EUS biopsy significantly impacts time between suspicion and treatment of PDAC. This may be exacerbated by clinical practices increasingly favoring neo-adjuvant therapy that necessitates biopsy-proven disease. Time to treatment may also be impacted by access to tertiary centers and racial disparities.
对手术候选者疑似胰腺癌（PDAC）进行活检是有帮助的，但并非总是必要的。活检会影响治疗方案，因为目前新辅助治疗需要组织学诊断，但不需要手术切除。我们探讨了在可切除和边界可切除 PDAC 患者中，通过内镜超声（EUS）活检来寻求组织诊断对治疗时间的影响。
对最终证实为 PDAC 的手术患者进行回顾性研究（2011-2021 年）。收集关键日期（怀疑癌症、活检、手术或新辅助治疗）。采用 Mann-Whitney-Wilcoxon 检验、Pearson's chi-squared 检验、Fisher's exact 检验、线性回归和 Cox 比例风险模型进行数据分析。
在 131 例可切除和 58 例边界可切除患者中，边界可切除组进行了更多的活检（1.2 次与 0.7 次，p<0.0001），更有可能在三级护理中心进行活检（67.2%与 30.5%，p<0.0001），并且治疗时间呈延长趋势（49 天与 44 天，p=0.070）。在黑种人（29 天，p=0.0002）和医疗保险（22 天，p=0.038）患者以及在三级护理中心未进行活检的患者（10 天，p=0.039）中，治疗时间显著增加。在调整了协变量后，额外的活检显著延迟了治疗（1 次活检：21 天，p=0.0001；2 次活检：44 天，p<0.0001；3 次活检：68 天，p<0.0001）。
EUS 活检显著影响 PDAC 从怀疑到治疗的时间。这可能因临床实践越来越倾向于新辅助治疗而加剧，新辅助治疗需要经活检证实的疾病。治疗时间也可能受到获得三级中心和种族差异的影响。
