Ejie Jonathan, Ashraf Ganjouei Amir, Hernandez Sophia, Wang Jaeyun Jane, Romero-Hernandez Fernanda, Foroutani Laleh, Hirose Kenzo, Nakakura Eric, Corvera Carlos Uriel, Alseidi Adnan, Adam Mohamed Abdelgadir
Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA.
School of Medicine, University of California San Francisco, San Francisco, CA 94143, USA.
Cancers (Basel). 2025 Jan 7;17(2):170. doi: 10.3390/cancers17020170.
(1) Background: Comprehensive evaluation of guideline-concordant care (GCC) across all PDAC stages has yet to be thoroughly conducted. This study aimed to characterize treatment patterns and assess factors associated with receiving GCC among patients with pancreatic ductal adenocarcinoma (PDAC) in California. (2) Methods: Data on adult patients with PDAC were extracted from the California Cancer Registry (2004-2020). GCC is defined according to the recommendations provided by the National Comprehensive Cancer Network. We used multivariable logistic regression to identify factors associated with receiving GCC. A Cox model was used to examine the association of GCC with overall survival. (3) Results: A total of 50,346 PDAC patients were included (stage 1: 10%; stage 2: 25%; stage 3: 11%; stage 4: 54%). Only 46.7% of all patients received GCC (stage 1: 20%; stage 2: 40%; stage 3: 69%; stage 4: 50%). Only 31% of stage 1 patients underwent surgery. Factors inversely associated with receiving GCC were Hispanic ethnicity (OR 0.78; < 0.001), Black race (OR 0.74; < 0.001), having no insurance (OR 0.40; < 0.001]), and a Charlson-Deyo score of ≥2 (OR 0.68; < 0.001). Adherence to GCC was associated with improved survival (Hazard Ratio 0.39; < 0.001). Notably, patients with stage 1 PDAC who received GCC had a median survival of 47 months vs. 8 months for those who did not. (4) Conclusions: Although stage 1 PDAC patients have the greatest potential for survival with GCC, only 20% of patients received such treatment. Thus, it is crucial to identify and address the modifiable factors contributing to these suboptimal care patterns.
(1) 背景：尚未对所有胰腺癌阶段的指南一致性护理（GCC）进行全面评估。本研究旨在描述加利福尼亚州胰腺导管腺癌（PDAC）患者的治疗模式，并评估与接受GCC相关的因素。(2) 方法：从加利福尼亚癌症登记处（2004 - 2020年）提取成年PDAC患者的数据。GCC根据美国国立综合癌症网络提供的建议进行定义。我们使用多变量逻辑回归来确定与接受GCC相关的因素。采用Cox模型检验GCC与总生存期的关联。(3) 结果：共纳入50346例PDAC患者（1期：10%；2期：25%；3期：11%；4期：54%）。所有患者中只有46.7%接受了GCC（1期：20%；2期：40%；3期：69%；4期：50%）。1期患者中只有31%接受了手术。与接受GCC呈负相关的因素包括西班牙裔（比值比0.78；<0.001）、黑人种族（比值比0.74；<0.001）、无保险（比值比0.40；<0.001）以及Charlson - Deyo评分≥2（比值比0.68；<0.001）。遵循GCC与生存期改善相关（风险比0.39；<0.001）。值得注意的是，接受GCC的1期PDAC患者中位生存期为47个月，而未接受者为8个月。(4) 结论：尽管1期PDAC患者接受GCC时生存潜力最大，但只有20%的患者接受了此类治疗。因此，识别并解决导致这些次优护理模式的可改变因素至关重要。
