Treatment at High-Volume Center Improved Pancreatic Cancer Survival

Patients with pancreatic cancer who received adjuvant chemotherapy at a high-volume center had superior median and 5-year overall survival compared with patients who were treated in a community setting, according to the results of a study presented at the 2016 American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium, held January 21–23 in San Francisco (abstract 191).

“A large body of evidence supports a volume-outcome relationship for pancreatic cancer resection, yet surgery alone is not sufficient to achieve cure (5-year survival) in patients with localized disease. In this study we sought to identify whether volume is associated with superior outcomes in the adjuvant therapy setting,” Meg Mandelson, PhD, MPH, of Floyd & Delores Jones Cancer Institute at Virginia Mason in Seattle, told Cancer Network. “Patient volume itself may be an indicator for multidisciplinary treatment planning, experience on the part of clinicians and staff, and/or better supportive services, so that a high percentage of patients complete therapy.”

For the study, the researchers enrolled 245 patients diagnosed with pancreatic cancer between 2003 and 2014. All patients were resected at a high-volume center; 57% received adjuvant therapy at a high-volume center and 43% were treated at a community center. Patients treated at a community center were older (68.2 vs 63.1 years; P < .01), but were similar with respect to stage, tumor size, and resection margins.

Study results showed that a highly select group of patients with localized pancreatic cancer who underwent successful surgical resection at a high-volume institution had significantly longer overall survival (44 vs 28 months; P < .01) and superior 5-year survival (39% vs 25%; P < .01) compared with similar patients resected at a high-volume center who received adjuvant therapy from community providers. Adjusting the data for the difference in age did not affect the results.

According to Mandelson, this finding was not surprising because literature suggests many patients with pancreatic cancer receive no chemotherapy or single-agent treatment only, while the standard of care at the high-volume center in this study (Virginia Mason) is multimodality therapy-combination chemotherapy with or without radiation.

“This is only one small study and by itself does not warrant change in practice,” said Mandelson. “Nevertheless, pancreatic cancer patients eligible for surgical resection should consider surgery at a high-volume institution and continuing care in that setting. Importantly, we hope that other centers that treat many of these patients will conduct similar analysis in their surgical patients.”