Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States.
Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States; Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
J Gastrointest Surg. 2024 Jun;28(6):830-835. doi: 10.1016/j.gassur.2024.03.008. Epub 2024 Mar 12.
It remains unclear today whether the poor prognosis of pancreatic ductal adenocarcinoma (PDAC) was further worsened by the COVID-19 pandemic and whether this may affect providers and patients, today. Hence, this study aimed to investigate the effect of COVID-19 on care delivery and outcomes of patients with PDAC in the United States.
The National Cancer Database was queried for PDAC, between 2017 and 2020. Changes in the number of diagnoses and treatment patterns were compared annually for the entire cohort. Changes in surgical outcomes and median time from diagnosis to treatment were compared and analyzed. Chi-square, Mann-Whitney U, and Kruskal-Wallis tests were performed.
Of 127,613 patients with PDAC, PDAC diagnoses from 2017 (30,573) to 2019 (33,465) increased but decreased in 2020 (31,218). The number of patients receiving surgery or radiotherapy was stable between 2017 to 2019 (21.75% ± 0.05% and 13.9% ± 0.3%, respectively) but decreased in 2020 (20.7% and 12.4% respectively). Although patients received chemotherapy with increasing frequently from 2016 (60.7%) to 2019 (63.5%), this trend stopped in 2020 (63%). Of 27,490 patients undergoing surgery, the mean time from diagnosis to surgery increased from 2017 (34 days) to 2019 (56 days), with an increase in delay in 2020 (81 days). Moreover, patients who were tested for COVID-19, had a longer median time from diagnosis to surgery even if tested negative (COVID+, 140 days; COVID-, 112 days; P < .001).
Although the oncologic quality of PDAC surgery remained the same during the pandemic, not only did the pandemic lead to an underdiagnosis of PDAC and care delays, but even the suspicion of COVID-19 in patients with a negative test adversely affected their care.
目前尚不清楚 COVID-19 大流行是否进一步恶化了胰腺导管腺癌（PDAC）的预后，以及这是否会影响当今的医疗服务提供者和患者。因此，本研究旨在调查 COVID-19 对美国 PDAC 患者治疗的影响。
从 2017 年至 2020 年，国家癌症数据库对 PDAC 进行了查询。对整个队列的每年诊断数量和治疗模式变化进行了比较。比较并分析了手术结果和从诊断到治疗的中位时间的变化。进行了卡方检验、Mann-Whitney U 检验和 Kruskal-Wallis 检验。
在 127613 名 PDAC 患者中，2017 年（30573 例）至 2019 年（33465 例）的 PDAC 诊断有所增加，但 2020 年（31218 例）则有所减少。接受手术或放疗的患者数量在 2017 年至 2019 年期间保持稳定（分别为 21.75%±0.05%和 13.9%±0.3%），但在 2020 年有所下降（分别为 20.7%和 12.4%）。尽管接受化疗的患者比例从 2016 年（60.7%）增加到 2019 年（63.5%），但这一趋势在 2020 年停止（63%）。在 27490 名接受手术的患者中，从诊断到手术的平均时间从 2017 年（34 天）增加到 2019 年（56 天），而 2020 年的延迟增加（81 天）。此外，即使检测结果为阴性，接受 COVID-19 检测的患者从诊断到手术的中位时间也更长（COVID+，140 天；COVID-，112 天；P<0.001）。
尽管大流行期间 PDAC 手术的肿瘤学质量保持不变，但大流行不仅导致 PDAC 的漏诊和治疗延迟，而且即使 COVID-19 检测结果为阴性，对患者的怀疑也会对他们的治疗产生不利影响。
