title: EUS and survival in patients with pancreatic cancer: a population-based study.
abstract: BACKGROUND
  There is no direct evidence that EUS improves patient outcome.
  
  
  OBJECTIVE
  To study the association of undergoing EUS with survival in patients with pancreatic adenocarcinoma.
  
  
  METHODS
  Population-based study.
  
  
  METHODS
  Persons aged 65 years and older with a diagnosis of pancreatic cancer who were captured in the linked Surveillance Epidemiology and End Results-Medicare database between 1994 and 2002 were identified.
  
  
  METHODS
  Demographic, cancer-specific, and EUS procedural information was extracted, and survival curves were compared for patients who underwent EUS in the peridiagnostic period (1 month before the diagnosis to 3 months after the date of diagnosis: group I) with those who had not undergone EUS (group II).
  
  
  METHODS
  Relative hazard ratios for survival.
  
  
  RESULTS
  A total of 8616 patients with pancreatic adenocarcinoma were identified. Only 610 (7.1%) patients underwent EUS evaluation. In patients with locoregional cancer, the median survival (interquartile range) in group I and II patients was 10 (5-17) and 6 (2-12) months, respectively, P < .0001. There were more patients with early-stage disease in group I than group II (69.3% vs 36.2%, P < .001). Curative-intent surgery, chemotherapy, and radiation therapy were also performed more frequently in the patients in group I. Undergoing EUS, adjusted for age, race, sex, tumor stage, curative-intent surgery, chemotherapy, radiation therapy, and comorbidity score, was an independent predictor of improved survival (relative hazard, 0.71; 95% CI, 0.63-0.79).
  
  
  CONCLUSIONS
  Retrospective design.
  
  
  CONCLUSIONS
  EUS evaluation is independently associated with improved outcome in patients with locoregional pancreatic cancer, possibly because of detection of earlier cancers and improved stage-appropriate management including more selective performance of curative-intent surgery.
authors.affiliation: Division of Gastroenterology, Mayo Clinic Arizona, Scottsdale, Arizona 85259, USA.
authors.forename: Saowanee
authors.initials: S
authors.lastname: Ngamruengphong
authors.forename: Feng
authors.initials: F
authors.lastname: Li
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhou
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cooper
authors.forename: Ananya
authors.initials: A
authors.lastname: Das
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000368:Aged; D039702:Current Procedural Terminology; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate; D014481:United States