Abstract C070: Management of resectable pancreatic adenocarcinoma: Results from a data-driven approach across University of California system
Authors: Zack Travis , Ashraf-Ganjouei Amir , Giles Kurt , Adam Mohammed , Hong Julian , Tempero Margaret , Collisson Eric 
Published: January 2024

Introduction Practice guidelines for resection of surgical candidates in pancreatic adenocarcinoma are consensus-driven to ensure patients receive standardized care, but current evidence regarding peri-operative strategies regarding systemic and chemoradiation treatment is based on retrospective and metanalysis, which may lead to wide variation in implementation. Methods We used a database containing deidentified data patients with pancreatic adenocarcinoma who received surgical resections across five California academic medical centers to assess peri-operative outcomes and treatment strategies. We identified length of post-operative stay, rates of post-surgical hospital readmissions, pre-operative CA19-9 values, rates, type, duration and amount of neo-adjuvant, adjuvant, and chemoradiation therapy using structured data from EMR records at these sites. ANOVA, t-test and fisher exact tests were used to determine statistical significance of differences across institutions. Cox regression models were used to determine significance in survival differences between populations. Results. We identified 2,564 patients with PDAC diagnosis who had a surgical resection of the pancreas across five University of California sites. 1948 received pancreaticoduodenectomy, 549 received distal pancreatectomies, and 67 received total pancreatectomies. Median LOS was 8.0 days, with 7-day, 30-day, and 90-day readmission rates of 7.6, 17.7 and 23.2% respectively. There were significant differences in these rates across the five medical centers, though no association with site volume. Rate of completion of 6 months of peri-operative 5-FU based systemic therapy was 62% across all sites, but only 47% for 12 cycles of FOLFIRINOX. Patients receiving at least some NAC therapy more likely to complete the recommend six months than those who did not get any systemic therapy prior to surgical resection (77.8% vs 49.3%, p-value&lt;0.001, Logistic regression with Wald test for significance). There were significant differences in the timing of peri-operative therapy across the sites, as well as the frequency of using pre- and post-operative chemo-radiation. Pre-operatively CA19-9, as well as use of perioperative Gemcitabine/Abraxane or FOLFIRINOX over Gemcitabine monotherapy were significant predictors of overall survival. Conclusion Post-operative length of stay and readmission rates were significantly different across these institutions, suggesting differential efficacy in supportive care strategies. Similarly, there is significant variation of peri-operative systemic therapy strategies. Patients receiving neoadjuvant systemic therapy are significantly more likely to complete the guideline recommended six months of treatment. Rates of peri-operative chemoradiation were significantly different across medical centers, without corresponding difference in overall survival. By comparing practice differences across institutions, we may better understand how these differences affect efficacy.

Citation Format: Travis Zack, Amir Ashraf-Ganjouei, Kurt Giles, Mohammed Adam, Julian Hong, Margaret Tempero, Eric Collisson. Management of resectable pancreatic adenocarcinoma: Results from a data-driven approach across University of California system [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr C070.