title: Modest improvement in overall survival for patients with metastatic pancreatic cancer: a trend analysis using the surveillance, epidemiology, and end results registry from 1988 to 2008.
abstract: OBJECTIVE
  Patients with pancreatic adenocarcinoma often present with distant metastatic disease. We aimed to assess whether improvements in survival of clinical trials translated to a population-based level.
  
  
  METHODS
  The US Surveillance, Epidemiology, and End Results registry was queried. Adult patients with distant metastatic adenocarcinoma of the pancreas were included from 1988 to 2008. Overall survival was analyzed using Kaplan-Meier curves as well as multivariable-adjusted Cox proportional hazards models.
  
  
  RESULTS
  In total, 32,452 patients were included. Mean age was 67.6 (SD: 11.7) years, and 15,341 (47.3%) were female. Median overall survival was 3 months (95% confidence interval [CI], 3-3 months), which increased from 2 (CI, 2-2) months in 1988 to 3 (CI, 3-4) months in 2008. After adjustment for multiple covariates, the hazard ratio (HR) decreased by 0.977 per year (CI, 0.975-0.980). In multivariable-adjusted survival analyses, tumor location in the pancreatic body/tail (HR, 1.10), male sex (HR, 1.09), increasing age (HR, 1.016), African American ethnicity (HR, 1.16), nonmarried civil status (HR, 1.18), and absence of radiotherapy (HR, 1.41) were associated with worse survival (P < 0.001 for all predictors).
  
  
  CONCLUSIONS
  The improvement in overall survival over the past 2 decades among patients with metastatic pancreatic adenocarcinoma is modest and disappointing. More effective therapeutic strategies for advanced disease are desperately needed.
authors.affiliation: From the *Department of Surgery, Duke University Medical Center, Durham, NC; †Department of Visceral Surgery and Medicine, University of Bern, Bern; and ‡Department of Medical Oncology and Hematology, Cantonal Hospital St Gallen, Gallen, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Worni
authors.forename: Ulrich
authors.initials: U
authors.lastname: Guller
authors.forename: Rebekah R
authors.initials: RR
authors.lastname: White
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Castleberry
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: Thomas
authors.initials: T
authors.lastname: Cerny
authors.forename: Beat
authors.initials: B
authors.lastname: Gloor
authors.forename: Dieter
authors.initials: D
authors.lastname: Koeberle
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality*; D016016:Proportional Hazards Models; D018426:SEER Program; D013997:Time Factors; D014481:United States / Q000453:epidemiology