Nationwide trends over 10 years in epidemiology and management of pancreatic ductal adenocarcinoma: A real-world study from the French administrative database

• Published in: Clinics and research in hepatology and gastroenterology 2024-10, Vol.48 (8), p.102426, Article 102426
• Main Authors: Mas, Léo, Castelli, Christel, Coffy, Amandine, Tretarre, Brigitte, Piquemal, David, Bachet, Jean-Baptiste
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Carcinoma, Pancreatic Ductal - epidemiology; Carcinoma, Pancreatic Ductal - mortality; Carcinoma, Pancreatic Ductal - therapy; Databases, Factual; Female; France - epidemiology; Humans; Incidence; Male; Middle Aged; Neoadjuvant Therapy; Pancreatic Neoplasms - epidemiology; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - therapy; PDAC; Population-based; Survival Rate; Therapeutic strategies; Time Factors
• ISSN: 2210-7401; 2210-741X; 2210-741X
• DOI: 10.1016/j.clinre.2024.102426

•Nationwide analysis of PDAC real-world treatments and outcomes over 10 years.•Nearly 30 000 patients included between 2009 and 2018.•Confirmation of the rising incidence of PDAC mainly among patients > 60 years.•Significant increase of neoadjuvant strategies and chemotherapy delivery.•Improved outcomes in treated patients and modest survival gain overall. Significant progress has been made in the management of pancreatic ductal adenocarcinoma (PDAC) in recent years. In this population-based study, we aimed to compare incidence, therapeutic strategies, and survival outcomes of PDAC patients in France over a decade. This study was performed using a nationwide French database. All patients receiving care for PDAC during years 2009, 2014 and 2018 were included. Treatment modalities and survival outcomes were analyzed. A total of 8143/8771/10494 patients were considered in 2009/2014/2018, respectively. Incidence increased mainly among patients aged >60 years. In localized PDAC, the proportion of patients receiving best supportive care (BSC) only decreased at 43.6/36.4/32.4 % and 27.8/29.1/34.3 % received chemo(radio)therapy alone. The rate of upfront surgery remained stable while 3/8/18 % of operated patients received neoadjuvant therapy. Median overall survival (OS) was 7.0/7.9/8.5 months in the overall population. Among treated patients, 1-year OS was 61.4/67.7/68.8 % and 30.3/36.3/38.8 % for localized and metastatic PDAC, respectively. This study confirms the rising incidence of PDAC. Improved outcomes were seen in localized PDAC, with a wider use of chemotherapy and neoadjuvant strategies, and in treated metastatic patients. A modest survival gain was seen overall, hindered by the still high rate of patients receiving BSC only.