Pancreas

--Senner SF, Fremgen AM, Menck HR, Winchester DP. Pancreatic cancer: A report of treatment and survival trends for 100,313 patients diagnosed from 1985-1995, using the National Cancer Data Base. JACS 1999; 189:1-7. (!)

--Janes RH, Niederhuber JE, Chmiel JS, Winchester DP, Zuber-Ocwieja KE, Karnell LH, Clive RE, Menck HR. National patterns of care for pancreatic cancer: Results of a survey by the Commission on Cancer. Ann Surg 1996; 223:261-272. (*) (!)

The survey questionnaire contained 160 questions and covered two study periods, 1983 to 1985 and 1990, for time-trend analysis. Nine hundred seventy-eight institutions throughout the United States voluntarily participated, contributing 8,917 case reports for 1983 to 1985 and 8,025 reports for 1990, resulting in a total of 16,942 patient reports. Most, but not all, of the participating hospitals maintain approval status with the Commission on Cancer of the American College of Surgeons. The ratio of male-to-female cases was 1:1. Age, ethnicity, neighborhood income, type of insurance coverage, and hospital characteristics-- including annual caseload and type of facility (i.e., teaching, community)--appeared to influence surgical multimodality treatment patterns. The most common presenting symptom was abdominal pain. The reported history of smoking for these patients with pancreatic cancer was higher than U.S. population averages. The frequency of using abdominal CT scans, endoscopic retrograde cholangiopancreatography, carcinoembryonic antigen, and CA 19-9 during patient evaluation all increased. Time trends toward lower operative mortality and more extirpative surgery were reported, as was a slightly higher survival for those patients who were resected surgically.

--Niederhuber JE, Brennan MF, Menck HR. The National Cancer Data Base report on pancreatic cancer. Cancer 1995; 76:1671-1677.

Three Calls for Data yielded a total of 17,490 cases for 1985, 1986, and 1991, from 937 hospital cancer registries across the United States. The data for 1991 represent 325 of all pancreatic cancer cases for the U.S. A higher incidence of more advanced disease was reported for the youngest group of patients, Hispanics, African-Americans, Asians, males, and patients seen at smaller hospitals. For all the patients combined, only 14.2% were reported to have had a pancreatectomy. Older patients, patients from lower-income zip codes, and African-Americans were somewhat less likely to have received a pancreatectomy. Cancer of the body of the pancreas was the anatomic subsite for which patients with pancreatic cancer were least likely to receive a pancreatectomy. Patients seen at hospitals with larger caseloads and at teaching hospitals were more frequently reported as having had a pancreatectomy. Between 1985-1986 and 1991, there was a trend from treatment with surgery only or radiation only toward more frequent use of combined chemoradiation without surgery. There was less radiation treatment reported as received by patients at hospitals with larger caseloads. For patients with resectable tumors, a moderate survival advantage was reported compared with nonresectable tumors: 1-year, 48% versus 23%; 2-year, 24% versus 9%; 3-year, 17% versus 6%, respectively.

--Niederhuber JE. Pancreatic cancer. In: Steele GD, Winchester DP, Osteen RT, Menck HR, Murphy GP: eds. National Cancer Data Base: Annual review of patient care, 1994. Atlanta, GA: American Cancer Society, 1994.

Data were received on 3,996 pancreatic cancer cases from 464 hospitals in 1985, 4,372 cases from 474 hospitals in 1986, and 9,122 cases from 937 hospitals in 1991. These data represent approximately 16%, 17%, and 32% of all pancreatic cancers in the United States in 1985, 1986, and 1991, respectively. The NCDB data show the number of male and female cases essentially equal, compared with previous reports of a 1.13:1 male to female case ratio. This apparent equalization of male and female risk may be related to observations confirming that high numbers of women continue to use tobacco and NCDB data confirming that 49% of pancreatic cancer patients have a significant smoking history. Several continuing trends, such as a growing percentage of cases in urban populations compared with rural regions, and more advanced disease at diagnosis in young patients, patients seen at smaller hospitals, Hispanics, African-Americans, Asians, and males, provide important reference points for evaluating future trends in the management of pancreatic cancer.

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