ARTICLE: Recent trends in the incidence and survival of Stage 1A Pancreatic Cancer: A Surveillance, Epidemiology, and End Results analysis

AUTHORS: Amanda L Blackford, Marcia Irene Canto, Alison P Klein, Ralph H Hruban, Michael Goggins

JOURNAL:  2020 Jan 20. pii: djaa004. doi: 10.1093/jnci/djaa004. [Epub ahead of print]


BACKGROUND: Rapid access to pancreatic imaging and regular pancreatic surveillance may help identify Stage I pancreatic cancer. We investigated recent trends in the stage of newly-diagnosed PDACs, age at diagnosis, and survival.

METHODS: Trends in age-adjusted incidence of Stage IA pancreatic ductal adenocarcinoma (PDAC) between 2004 and 2016 were determined from the National Cancer Institute's SurveillanceEpidemiology and End Results (SEER) database. All tests were two-sided.

RESULTS: The incidence of Stage IA PDAC cases diagnosed increased statistically significantly from 2004 to 2016 (annual percent change (APC): 14.5, 95% confidence interval (CI) [11.4, 17.7], p < 0.001). During the study period, average age at diagnosis for Stage IA and IB cases declined by 3.5 y (95% CI: 1.2-5.9y; p = 0.004) and 5.5 years (95%CI= 3.4-7.6y; p < 0.001), whereas average age increased for higher-stage cases (by 0.6 to 1.4 years). Among Stage IA cases the proportion of blacks was smaller (10.2% v. 12.5%), and the proportion of other non-Caucasians was higher compared to higher-stage cases (11.9% v. 8.4%, p < 0.001). Stage IA cases were more likely to carry insurance (versus Medicaid/none) than higher-stage cases; (cases aged <65; odds ratio=2.45 [95%CI=1.96, 3.06], p < 0.001). The 5-year overall survival for Stage IA PDAC improved from 44.7% [95%CI=31.4, 63.7] in 2004 to 83.7% [95%CI=78.6%, 89.2%] in 2012; 10-year survival improved from 36.7% [95%CI=24.1, 55.8] in 2004 to 49.0% [95%CI=37.2%, 64.6%] in 2007.

CONCLUSIONS: In recent years the proportion of patients diagnosed with Stage IA PDAC has increased, their average age at diagnosis has decreased, and their overall survival has improved. These trends may be the result of improved early diagnosis and early detection.

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Improvements in screening may be linked to increase in early-stage pancreatic cancer diagnoses -Healio

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