Hepatopancreatobiliary malignancies: time to treatment matters

Authors

Daniel M. Kerekes, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.Follow
Alexander E. Frey, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.Follow
Baylee F. Bakkila, Yale School of Medicine, New Haven, CT, USA.Follow
Caroline H. Johnson, Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA.Follow
Robert D. Becher, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.Follow
Kevin G. Billingsley, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.Follow
Sajid A. Khan, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.Follow

Document Type

Article

Publication Title

Journal of gastrointestinal oncology

Abstract

BACKGROUND: Initiation of oncologic care is often delayed, yet little is known about delays in hepatopancreatobiliary (HPB) cancers or their impact. This retrospective cohort study describes trends in time to treatment initiation (TTI), assesses the association between TTI and survival, and identifies predictors of TTI in HPB cancers. METHODS: The National Cancer Database was queried for patients with cancers of the pancreas, liver, and bile ducts between 2004 and 2017. Kaplan-Meier survival analysis and Cox regression were used to investigate the association between TTI and overall survival for each cancer type and stage. Multivariable regression identified factors associated with longer TTI. RESULTS: Of 318,931 patients with HPB cancers, median TTI was 31 days. Longer TTI was associated with increased mortality in patients with stages I-III extrahepatic bile duct (EHBD) cancer and stages I-II pancreatic adenocarcinoma. Patients treated within 3-30, 31-60, and 61-90 days had median survivals of 51.5, 34.9, and 25.4 months (log-rank P<0.001), respectively, for stage I EHBD cancer, and 18.8, 16.6, and 15.2 months for stage I pancreatic cancer, respectively (P<0.001). Factors associated with increased TTI included stage I disease (+13.7 days vs. stage IV, P<0.001), treatment with radiation only (β=+13.9 days, P<0.001), Black race (+4.6 days, P<0.001) and Hispanic ethnicity (+4.3 days, P<0.001). CONCLUSIONS: Some HPB cancer patients with longer time to definitive care experienced higher mortality than patients treated expeditiously, particularly in non-metastatic EHBD cancer. Black and Hispanic patients are at risk for delayed treatment. Further research into these associations is needed.

First Page

833

Last Page

848

DOI

10.21037/jgo-22-1067

Publication Date

4-29-2023

Recommended Citation

Kerekes, Daniel M.; Frey, Alexander E.; Bakkila, Baylee F.; Johnson, Caroline H.; Becher, Robert D.; Billingsley, Kevin G.; and Khan, Sajid A., "Hepatopancreatobiliary malignancies: time to treatment matters" (2023). Surgery. 204.
https://scholar.bridgeporthospital.org/surgery/204

Identifier

37201090 (pubmed); PMC10186552 (pmc); 10.21037/jgo-22-1067 (doi); jgo-14-02-833 (pii)