Nationwide trends in incidence, treatment and survival of patients with pancreatic cancer in the past two decades

Background: This population-based study aims to evaluate trends in incidence, treatment and survival of pancreatic cancer in the past two decades. Material & Methods: A total of 38,358 patients with pancreatic cancer between 1997-2016 were derived from the Netherlands Cancer Registry. Incidence rates were described based on the European standard population (ESP) and the revised ESP (RESP). Overall survival (OS) data were calculated using the Kaplan-Meier method. Results were presented per period of diagnosis. Multivariable cox regression was used to analyze the association between adjuvant chemotherapy and survival. Results: The incidence of pancreatic cancer increased from 8.0 to 10.5 per 100.000 persons (ESP-based, Estimated Annual Percent Change 1.8%, p<0.001), especially adenocarcinoma. Over time, more patients with pancreatic adenocarcinoma underwent resection (8.3% in 1997-2000 vs. 16.6% in 2013-2016, p<0.001). The use of adjuvant chemotherapy increased from 2.8% in 1997-2000 to 51.9% in 2013-2016 (p<0.001). After adjustment for age, radiotherapy and period of diagnosis, adjuvant chemotherapy significantly improved OS compared to patients without chemotherapy before or after resection (adjusted HR 0.63, 95%CI 0.58-0.68). The use of chemotherapy in patients without a resection increased from 7.4% in 1997-200 to 22.0% in 2013-2016 (p<0.001). Median OS was 3.5 months (95%CI 3.5-3.6) for all patients and 16.9 months (95%CI 16.4-17.4) in those who underwent a resection. Between 1997-2000 and 2013-2016 an OS increase was observed (3.1 months (95%CI 2.9-3.2) to 3.8 months (95%CI 3.7-4.0) p<0.001) in all patients. In patients who underwent resection OS improved from 14.0 (95%CI 12.6-15.5) to 18.2 months (95%CI 17.2-19.2) (p<0.001) and in patients with chemotherapy for metastatic disease from 4.6 (95%CI 4.0-5.3) to 6.3 months (95%CI 5.9-6.7) (p<0.001). Conclusion: Between 1997 and 2016 the incidence of pancreatic cancer increased 8.0 to 10.5 per 100.000 persons. The resection rates and use of chemotherapy increased which probably explains the improvement of OS.