Skip to main content
SpringerLink
Log in

Pancreatic ductal adenocarcinoma: exploring clinicopathological trends and racial disparities in a comprehensive U.S. population-based study

  • Research Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Introduction

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy about 50% of PDAC are metastatic at presentation. In this study, we evaluated PDAC demographics, annual trend analysis, racial disparities, survival rate, and the role of different treatment modalities in localized and metastatic disease.

Methods

A total of 144,824 cases of PDAC were obtained from the SEER database from 2000 to 2018.

Results

The median age was 69 years, with a slightly higher incidence in males (52%) and 80% of all cases were white. Among cases with available data, 43% were grade III tumors and 57% were metastatic. The most common site of metastasis was the liver (15.7%). The annual incidence has increased steadily from 2000 to 2018. The overall observed (OS) 5-year survival rate was 4.4% (95% CI 4.3–4.6%), and 5 years cause-specific survival (CSS) was 5% (95% CI 5.1–5.4%). The 5-year survival with multimodal therapy (chemotherapy, surgery, and radiation) was 22% (95% CI 20.5–22.8%). 5-year CSS for the blacks was lower at 4.7% (95% CI 4.2–5.1%) compared to the whites at 5.3% (95% CI 5.1–5.4%). Multivariate analysis found male gender and black race associated with worse prognosis. Kaplan–Meier survival analysis found multimodal therapy to have the best outcomes in all three stages.

Conclusion

PDAC is an aggressive malignancy with male gender and black race are associated with a poor prognosis. Surgery with chemoradiation was associated with the best overall survival. With steadily increasing rates of PDAC, improved treatment modalities are paramount to improving survival in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

All data are publicly available and will be provided upon appropriate request from the corresponding author.

References

  1. Miller KD, Ortiz AP, Pinheiro PS, Bandi P, Minihan A, Fuchs HE, et al. Cancer statistics for the US Hispanic/Latino population, 2021. CA Cancer J Clin. 2021;71(6):466–87.

    Article  PubMed  Google Scholar 

  2. Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74(11):2913–21.

    Article  CAS  PubMed  Google Scholar 

  3. Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA, editors. SEER cancer statistics review, 1975–2016, National Cancer Institute. Bethesda, MD. Based on November 2018 SEER data submission, posted to the SEER web site, April 2019. https://seer.cancer.gov/csr/1975_2016/.

  4. Modolell I, Guarner L, Malagelada JR. Vagaries of clinical presentation of pancreatic and biliary tract cancer. Ann Oncol. 1999;10(Suppl 4):82–4.

    Article  PubMed  Google Scholar 

  5. McGuigan A, Kelly P, Turkington RC, Jones C, Coleman HG, McCain RS. Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol. 2018;24(43):4846–61.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hruban RH, Canto MI, Goggins M, Schulick R, Klein AP. Update on familial pancreatic cancer. Adv Surg. 2010;44:293–311.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Chen F, Roberts NJ, Klein AP. Inherited pancreatic cancer. Chin Clin Oncol. 2017;6(6):58.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A, et al. Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage. Clin Transl Oncol. 2005;7(5):189–97.

    Article  PubMed  Google Scholar 

  9. Bronstein YL, Loyer EM, Kaur H, Choi H, David C, DuBrow RA, et al. Detection of small pancreatic tumors with multiphasic helical CT. Am J Roentgenol. 2004;182(3):619–23.

    Article  Google Scholar 

  10. Niederau C, Grendell JH. Diagnosis of pancreatic carcinoma. Imaging techniques and tumor markers. Pancreas. 1992;7(1):66–86.

    Article  CAS  PubMed  Google Scholar 

  11. Kim JE, Lee KT, Lee JK, Paik SW, Rhee JC, Choi KW. Clinical usefulness of carbohydrate antigen 19-9 as a screening test for pancreatic cancer in an asymptomatic population. J Gastroenterol Hepatol. 2004;19(2):182–6.

    Article  PubMed  Google Scholar 

  12. Lynch SM, Vrieling A, Lubin JH, Kraft P, Mendelsohn JB, Hartge P, et al. Cigarette smoking and pancreatic cancer: a pooled analysis from the pancreatic cancer cohort consortium. Am J Epidemiol. 2009;170(4):403–13.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Springfeld C, Ferrone CR, Katz MHG, Philip PA, Hong TS, Hackert T, et al. Neoadjuvant therapy for pancreatic cancer. Nat Rev Clin Oncol. 2023;20(5):318–37.

    Article  PubMed  Google Scholar 

  14. Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364(19):1817–25.

    Article  CAS  PubMed  Google Scholar 

  15. Wainberg ZA, Melisi D, Macarulla T, Pazo Cid R, Chandana SR, De La Fouchardiere C, et al. NALIRIFOX versus nab-paclitaxel and gemcitabine in treatment-naive patients with metastatic pancreatic ductal adenocarcinoma (NAPOLI 3): a randomised, open-label, phase 3 trial. Lancet. 2023;402(10409):1272–81.

    Article  CAS  PubMed  Google Scholar 

  16. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):12–49.

    Article  PubMed  Google Scholar 

  17. Klein AP. Pancreatic cancer epidemiology: understanding the role of lifestyle and inherited risk factors. Nat Rev Gastroenterol Hepatol. 2021;18(7):493–502.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kolbeinsson HM, Chandana S, Wright GP, Chung M. Pancreatic cancer: a review of current treatment and novel therapies. J Invest Surg. 2023;36(1):2129884.

    Article  PubMed  Google Scholar 

  19. Goggins M, Overbeek KA, Brand R, Syngal S, Del Chiaro M, Bartsch DK, et al. Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the international cancer of the pancreas screening (CAPS) consortium. Gut. 2020;69(1):7–17.

    Article  CAS  PubMed  Google Scholar 

  20. Neoptolemos JP, Stocken DD, Bassi C, Ghaneh P, Cunningham D, Goldstein D, et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA. 2010;304(10):1073–81.

    Article  CAS  PubMed  Google Scholar 

  21. Neoptolemos JP, Palmer DH, Ghaneh P, Psarelli EE, Valle JW, Halloran CM, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017;389(10073):1011–24.

    Article  CAS  PubMed  Google Scholar 

  22. Conroy T, Hammel P, Hebbar M, Ben Abdelghani M, Wei AC, Raoul JL, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 2018;379(25):2395–406.

    Article  CAS  PubMed  Google Scholar 

  23. Kamarajah SK, Sonnenday CJ, Cho CS, Frankel TL, Bednar F, Lawrence TS, et al. Association of adjuvant radiotherapy with survival after margin-negative resection of pancreatic ductal adenocarcinoma: a propensity-matched national cancer database (NCDB) analysis. Ann Surg. 2021;273(3):587–94.

    Article  PubMed  Google Scholar 

  24. Heller DR, Nicolson NG, Ahuja N, Khan S, Kunstman JW. Association of treatment inequity and ancestry with pancreatic ductal adenocarcinoma survival. JAMA Surg. 2020;155(2): e195047.

    Article  PubMed  Google Scholar 

  25. Karimi P, Gordon-Dseagu VL, Chernyavskiy P, Goggins M, Rosenberg PS, Stolzenberg-Solomon R. Pancreatic cancer survival trends overall, by stage, and histologic sub-type: an analysis of surveillance, epidemiology and end results (SEER) population-based data (2000–2015). J Clin Oncol. 2019;37(15_suppl): e15772.

    Article  Google Scholar 

Download references

Funding

This research received no external funding.

Author information

Author notes

  1. Abdul Qahar Khan Yasinzai and Bisma Tareen contributed equally to this work and shared first coauthorship.

Authors and Affiliations

  1. Department of Medicine, Bolan Medical College, Quetta, 83700, Pakistan

    Abdul Qahar Khan Yasinzai, Bisma Tareen, Nimra Jamil, Hafeez Ullah, Muhammad Raza & Amin Ullah Khan

  2. Medical College of Georgia, Augusta, GA, 30912, USA

    Katharine Tracy

  3. Internal Medicine, Marshfield Medical Center, Marshfield, USA

    Marjan Khan

  4. Department of Surgery, San Joaquin General Hospital, French Camp, CA, 95231, USA

    Abdul Waheed & Feroze Sidhwa

  5. Department of Surgery, BayCare Health System, Tampa, FL, USA

    Subhasis Misra

  6. Department of Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, USA

    Nabin Raj Karki

  7. Department of Hematology-Oncology, Inova Schar Cancer Institute, University of Virginia, Fairfax, VA, 22031, USA

    Nagla Abdel Karim

  8. Department of Oncology Developmental Therapeutics, Novant Health, Charlotte, NC, USA

    Dauod Arif & Ludimila Cavalcante

  9. Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA

    Asad Ullah

Authors
  1. Abdul Qahar Khan Yasinzai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bisma Tareen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katharine Tracy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nimra Jamil
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marjan Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hafeez Ullah
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Muhammad Raza
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Amin Ullah Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Dauod Arif
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Abdul Waheed
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Feroze Sidhwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Subhasis Misra
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Nabin Raj Karki
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Nagla Abdel Karim
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Ludimila Cavalcante
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Asad Ullah
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization; Abdul Qahar Khan Yasinzai and Asad Ullah. Literature search; Katharine Tracy, Bisma Tareen, Nimra Jamil, Hafeez Ullah, Muhammad Raza. Writing—original draft preparation; Katharine Tracy, Abdul Qahar Khan Yasinzai, Bisma Tareen, Amin Ullah Khan. Writing—review and editing; Ludimila Cavalcante, Asad Ullah, Abdul Qahar Khan Yasinzai, Marjan Khan, Subhasis Misra, Abdul Waheed, Nabin Raj Karki, Nagla Abdel Karim and Feroze Sidhwa. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Abdul Qahar Khan Yasinzai.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Institutional review board statement

All data are publicly available, and no IRB was required.

Informed consent

Patient consent was waived due to this article using data from the SEER database, which is publicly available deidentified patient data from the National Cancer Institute (NCI), USA.

Ethical approval (Research involving human participants and/or animals)

The data is retrieved from SEER database, which is publicly available identified data from the National Cancer Institute (NCI), thus no IRB was required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file 1 (DOCX 449 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yasinzai, A.Q.K., Tareen, B., Tracy, K. et al. Pancreatic ductal adenocarcinoma: exploring clinicopathological trends and racial disparities in a comprehensive U.S. population-based study. Clin Transl Oncol (2024). https://doi.org/10.1007/s12094-024-03484-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12094-024-03484-7

Keywords

Search

Navigation