PD-009 Use of adjuvant chemotherapy after pancreatoduodenectomy for pancreatic cancer: a nationwide population-based study in the Netherlands

Abstract

Introduction: In patients with cancer of the pancreatic head, the only chance for long-term survival is pancreatoduodenectomy. Adjuvant chemotherapy is considered standard care since it has been shown to improve overall survival, regardless of age, gender and tumor stage. However, not all surgically treated patients receive adjuvant chemotherapy. The current nationwide study investigated which patient and tumor characteristics influenced the chance of receiving adjuvant chemotherapy treatment. Methods: All patients who underwent pancreatoduodenectomy for pancreatic cancer between 2008 and 2012 in The Netherlands were included. Data were obtained from the nationwide Netherlands Cancer Registry. Patients were categorized based on treatment with adjuvant chemotherapy. Groups were compared using chi-square tests. Relationships between patient characteristics and the chance for adjuvant chemotherapy treatment were analyzed by multivariable logistic regression analysis. Patients deceased within 90 days after surgical treatment (N = 87) or with a missing tumor stage (N = 9) were excluded from analysis. Results: In total 1,241 pancreatic-cancer patients underwent pancreatoduodenectomy. Of these patients 557 (45%) received adjuvant chemotherapy. Female patients and TNM stage II/III patients were more likely to receive adjuvant treatment (50% vs 45% for males, odds ratio (OR) 1.33 95%CI 1.03-1.71; TNM II/III: 52% vs 27% for stage I. OR 3.55 95%CI 2.49-5.07). Older patients were less likely to receive adjuvant chemotherapy (60-75 years: 52% vs 59% for younger patients, OR 0.63, 95%CI 0.47- 0.85; and patients older than75 years: 13%, OR 0.08 95%CI 0.05-0.13). Furthermore, patients diagnosed in 2008 had a significant lower chance for receiving adjuvant chemotherapy treatment compared to patients diagnosed in 2012 (29% vs 51%, OR 0.30 95%CI 0.20-0.46). Conclusion: Of the pancreatic cancer patients treated with pancreatoduodenectomy 45% received adjuvant chemotherapy. This percentage increased with time. Younger patients with tumor stage II or III had a higher chance for receiving adjuvant chemotherapy treatment.