Abstract
Background
The effect of treatment delay on survival in pancreatic ductal adenocarcinoma (PDAC)
remains unclear.
Aims
This study aimed to assess the prognostic impact of time to diagnosis and chemotherapy
in advanced PDAC and factors influencing the time intervals.
Methods
advanced PDAC patients receiving chemotherapy in five centers in the decade 2007–2016
were included. Key time points during care pathway from clinical presentation to beginning
of chemotherapy were retrospectively collected. Multivariate Cox proportional hazard
model was performed.
Results
A total of 409 patients were included (mean age 66.1 ± 10.3 years; 250 metastatic
(61%); 139 received FOLFIRINOX chemotherapy (34%). The median overall survival (OS)
was 7.2 months. The median times from first symptoms and from first specialist visit
to the beginning of chemotherapy were respectively 100 days and 47 days. None of time
intervals was significantly associated with OS. Significant prognostic factors were
FOLFIRINOX chemotherapy (HR 0.6 [0.5–0.8]; P < 0.001), metastasis (HR 1.6 [1.3–2.0]; P = 0.001), WHO PS ≥ 2 (HR 1.6 [1.2–2.1]; P < 0.001) and acute pancreatitis as first symptom (HR 2.9 [1.7–4.9]; P < 0.001). Jaundice shortened time to diagnosis (P < 0.001). Acute pancreatitis (P < 0.001) and diabetes (P = 0.01) increased time to treatment.
Conclusion
Wait times from clinical presentation to beginning of chemotherapy do not influence
survival in advanced PDAC.
Keywords
Abbreviations:
OS (overall survival), PDAC (pancreatic ductal adenocarcinoma), CHU (University Hospital Center), BMI (body mass index), CA 19.9 (Carbohydrate antigen 19–9), WHO PS (WHO performance status), HR (Hazard ratio)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 30, 2020
Accepted:
March 16,
2020
Received:
August 24,
2019
Identification
Copyright
© 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
