title: Non-surgical tissue biopsy among patients with advanced pancreatic cancer: effect on survival.
abstract: OBJECTIVE
  The aim was to determine the survival of patients with advanced, unresectable pancreatic cancer in relation to whether they underwent nonsurgical biopsy of their primary tumor.
  
  
  METHODS
  A total of 1481 patients with distant stage pancreatic cancer diagnosed between 1992 and 2001 who underwent radiation treatment but not cancer-directed surgery were analyzed. The design is a retrospective cohort study from the Surveillance, Epidemiology, and End Results program of the US National Cancer Institute. Survival curves were created using Kaplan-Meier method and compared via log-rank test.
  
  
  RESULTS
  Of 1481 patients (median age, 66 years) included in our analysis, 1406 (95%) underwent nonsurgical biopsy (95%) and 75 (5%) did not. There was no statistically significant difference in overall median survival according to receipt of nonsurgical biopsy (Kaplan-Meier curve, log-rank test = 0.09). A subgroup analysis of patients younger than 65 years who did not undergo biopsy revealed a hazard ratio of 1.76 (95% confidence interval, 1.14-2.72); that is, there was a 76% higher hazard for death among younger patients who did not undergo biopsy compared with those who did (P = 0.011).
  
  
  CONCLUSIONS
  Nonsurgical biopsy did not seem to negatively impact survival among patients with advanced pancreatic cancer.
authors.affiliation: Harvard School of Public Health, Boston, MA, USA. lhernan@mcw.edu
authors.forename: Lyndon V
authors.initials: LV
authors.lastname: Hernandez
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: Milton
authors.initials: M
authors.lastname: Eisner
authors.forename: Nalini M
authors.initials: NM
authors.lastname: Guda
authors.forename: Na
authors.initials: N
authors.lastname: Lu
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Geenen
authors.forename: Marc F
authors.initials: MF
authors.lastname: Catalano
mesh_terms: D000368:Aged; D001706:Biopsy / Q000706:statistics & numerical data*; D015331:Cohort Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000532:radiotherapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D012720:Severity of Illness Index