title: Trends in the treatment and outcome of pancreatic cancer in the United States.
abstract: BACKGROUND
  Although pancreatic cancer is the fourth leading cause of cancer death, few studies have evaluated population-based trends in diagnosis, management, and outcome.
  
  
  METHODS
  We used the Surveillance, Epidemiology, and End Results (SEER) registry to evaluate treatment trends and outcomes for patients 18 or older with pancreatic adenocarcinoma diagnosed from 1988 through 2002.
  
  
  RESULTS
  We identified 38,073 patients diagnosed with pancreatic cancer over this 15-year period; the age-adjusted incidence did not change over this period. Most patients were diagnosed with metastatic disease (50.3%), few of whom underwent irradiation or cancer-directed surgery (CDS). For patients with localized or regional disease (32.9%), 53% underwent some form of treatment. Importantly, the rate of CDS increased from 19% in 1988 to 35% in 2002 (P < 0.0001). In multivariate analysis, young age, married status, and localized disease were associated with significantly higher CDS rates. For patients with nonmetastatic disease, 2-year survival rate increased from 8% in 1988 to 15% in 2000. For patients with non-metastatic cancer who survived at least 3 months, CDS was associated with a significantly higher 2-year survival rate (CDS, 36%; non-CDS, 10%).
  
  
  CONCLUSIONS
  Most patients with pancreatic cancer, even at the end of our 15-year study period, still presented with metastatic disease, and the survival rate for such patients did not change in a meaningful way over time. The proportion of patients with nonmetastatic pancreatic cancer who underwent potentially curative surgery increased over time in the U.S.; the 2-year survival rate for such patients improved, but remained poor.
authors.affiliation: Division of General Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Baxter
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Whitson
authors.forename: Todd M
authors.initials: TM
authors.lastname: Tuttle
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008495:Medical Oncology / Q000639:trends*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D018426:SEER Program; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology