Trends in survival based on treatment modality in patients with pancreatic cancer: a population-based study

Background Pancreatic cancer (PCC) is one of the most lethal types of cancer, and surgery remains the optimal treatment modality for patients with resectable tumours. The objective of the present study was to examine and compare trends in the survival rate based on treatment modality in patients with PCC. Methods This population-based retrospective analysis included all patients with known-stage PCC in Ontario between 2007 and 2015. Flexible parametric models were used to conduct the survival analysis. Survival rates were calculated based on treatment modality, while adjusting for patient- and tumour-specific covariates. Results The study included 6437 patients. We found no noticeable improvement in survival for patients with stage III or IV tumours; however, for stage I disease, the 1-, 2-, and 5-year survival rates increased over time to 81% from 51%, to 71% from 35%, and to 61% from 22% respectively. Most improvements were seen for surgical modalities, with 2-year survivals increasing to 89% from 65% for distal pancreatectomy (DP) without radiation (RT) or chemotherapy (CTX), to 65% from 37% for DP plus RT or CTX, to 60% from 44% for Whipple- only, and to 50% from 36% for Whipple plus RT or CTX. Lastly, 5-year survival improved to 81% from 52% for DP only, to 41% from 12% for DP plus RT or CTX, to 49% from 25% for Whipple-only, and to 26% from 12% for Whipple plus RT or CTX. Conclusions Most cases of PCC continue to be diagnosed at a late stage, with poor short-term and long-term prognoses. After adjustment for patient age, sex, and year of diagnosis, the survival for stage I tumours and for surgical modalities increased over time. Further research is needed to identify the reasons for improvement in survival during the study period.