Survival outcomes in duodenal carcinoma based on facility type: A National Cancer Database analysis.
Authors: Masih Durva , Albagoush Sara , Abodunrin Faith , Tauseef Abubakar , Wu Xinxin , Ellithi Moataz , Silberstein Peter T. , Swedek Michelle 
Published: June 2023

e16328

Background: Duodenal Carcinoma (DC) is a rare entity, accounting for 0.5% of gastrointestinal tumors and up to 50% of all small intestinal tumors. Few studies have characterized survival outcomes in DC due to its rarity. This study aims to evaluate if Academic centers (AC) have better survival outcomes compared to Non-academic centers (NAC). Methods: A retrospective analysis of the National Cancer Database was conducted from 2004-2019 for subjects with DC, identified by ICD code C17.0 (n=26,070). Features were compared between patients (pts) at AC (n=15,020) and NAC (n=11,050). Overall survival (OS) was estimated using Kaplan Meier method and difference in OS was measured using pairwise log-rank test. Multivariate analysis was performed using binary logistic regression. Results: The median OS in pts with DC was 44 months. Treatment at AC was associated with a longer median OS than NAC (65 vs 32 months, p<0.001). Pts with higher Charleson/Deyo scores (CDS) of 2-3 were less likely to go to AC (OR 0.75, 95% CI 0.67-0.83, p<0.001). AC attracted age ranges <65 years compared to >70 years (OR 0.81, 95% CI 0.74 - 0.88, p<0.001) and >85 years (OR 0.53, 95% CI 0.47-0.60, p<0.001). African Americans (AA) and Asians were more likely to go to AC compared to Whites [(AA OR 1.21, 95% CI 1.13-1.3, p<0.001); (Asian OR 1.43, 95% CI 1.24-1.65, p< 0.001)]. Spanish/Hispanic pts were more likely to go to AC than non-Spanish/Hispanic (OR 1.26, 95% CI 1.13-1.41, p<0.001). Pts in upper income quartiles were more likely to be treated at AC (OR 1.19, 95% CI 1.08-1.32, p<0.001). Pts with Medicare (OR 0.71, 95% CI 0.60-0.83, p<0.001) were less likely to go to AC compared to uninsured pts. Pts from Central USA (OR 0.67, 95% CI 0.63-0.70, p <0.001) and the West Coast (OR 0.46, 95% CI 0.43-0.70, p<0.001) were less likely to go to AC compared to pts from the East Coast. Pts in rural areas were less likely to go to AC compared to those in metros (OR 0.70, 95% CI 0.57-0.87, p<0.001). The 30-day readmission rates after surgery were also studied. Unplanned 30-day readmission rates for surgically treated pts at AC were higher than those at NAC (OR 1.15, 95% CI 1.00-1.31, p=0.041). Conclusions: The median OS of pts with DC who were treated at AC was significantly longer compared to those treated at NAC. Pts with higher CDS were less likely to go to AC. AC had higher unplanned 30-day readmission rates for surgically treated pts than NAC. Pts with DC treated at AC were more likely to be uninsured, younger, and from ethnic minorities. Significant geographical differences also existed where pts from the East Coast and metros were more likely to go to AC compared to those in the West coast, Central and rural areas. Geography may play a role in serving densely populated urban centers where socio-economic factors drive larger minority population to AC facilities. Nonetheless, the difference in overall survival between AC and NAC deserves additional studies to improve outcomes of pts served by NAC.