title: Improvement of long-term outcomes in pancreatic cancer and its associated factors within the gemcitabine era: a collaborative retrospective multicenter clinical review of 1,082 patients.
abstract: BACKGROUND
  Although the outcomes of pancreatic cancer have been improved by gemcitabine, the changes in its characteristics and long-term outcomes within the gemcitabine era remain unclear. This study was conducted to identify clinical characteristics of pancreatic cancer patients within the gemcitabine era.
  
  
  METHODS
  A retrospective chart review was performed at 10 centers for 1,248 consecutive patients who were ever considered to have a diagnosis of pancreatic cancer between 2001 and 2010. Data collected included demographics, diagnosis date, clinical stage, treatment, and outcome 1,082 patients met the inclusion criteria and were analyzed further. The chi-square test, Student's t-test, and Mann-Whitney U-test were used for statistical analysis. Outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards regression. Differences in survival analyses were determined using the log-rank test.
  
  
  RESULTS
  The distribution of clinical stages was: I, 2.2% II, 3.4% III, 13% IVa, 27% and IVb, 55%. Chemotherapy alone was administered to 42% of patients and 17% underwent resection. The 1-, 3-, and 5-year survival rates were 39%, 13%, and 6.9%, respectively. The median survival time was 257 days, but differed considerably among treatments and clinical stages. Demographics, distribution of clinical stage, and cause of death did not differ between groups A (2001-2005, n=406) and B (2006-2010, n=676). However, group B included more patients who underwent chemotherapy (P<0.0001) and fewer treated with best supportive care (P=0.0004), mirroring improvements in this group's long-term outcomes (P=0.0063). Finally, factors associated with long-term outcomes derived from multivariate analysis were clinical stage (P<0.0001), location of the tumor (P=0.0294) and treatments (surgery, chemotherapy) (<0.0001).
  
  
  CONCLUSIONS
  Long-term outcomes in pancreatic cancer has improved even within the gemcitabine era, suggesting the importance of offering chemotherapy to patients previously only considered for best supportive care. Most patients are still diagnosed at an advanced stage, making clinical strategy development for diagnosing pancreatic cancer at earlier stages essential.
authors.forename: Taira
authors.initials: T
authors.lastname: Kuroda
authors.forename: Teru
authors.initials: T
authors.lastname: Kumagi
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yokota
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Seike
authors.forename: Mari
authors.initials: M
authors.lastname: Nishiyama
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Imai
authors.forename: Nobu
authors.initials: N
authors.lastname: Inada
authors.forename: Naozumi
authors.initials: N
authors.lastname: Shibata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Imamine
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Okada
authors.forename: Mitsuhito
authors.initials: M
authors.lastname: Koizumi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yamanishi
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Azemoto
authors.forename: Jiro
authors.initials: J
authors.lastname: Miyaike
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Haruka
authors.initials: H
authors.lastname: Tatsukawa
authors.forename: Hiroki
authors.initials: H
authors.lastname: Utsunomiya
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ohno
authors.forename: Teruki
authors.initials: T
authors.lastname: Miyake
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirooka
authors.forename: Shinya
authors.initials: S
authors.lastname: Furukawa
authors.forename: Masanori
authors.initials: M
authors.lastname: Abe
authors.forename: Yoshiou
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Bunzo
authors.initials: B
authors.lastname: Matsuura
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hiasa
authors.forename: Morikazu
authors.initials: M
authors.lastname: Onji
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine