Management and prognosis of pancreatic cancer over a 30-year period.

Background: The aim of this study was to report on changes in the diagnostic assessment, patterns of care and survival over time for pancreatic cancers.

Methods: A total of 2986 cases of pancreatic cancer from the Digestive Cancer Registry of Burgundy (France) over a 30-year period (1976-2005) were considered. Non-conditional logistic regressions were carried out to identify the factors associated with resection for cure and with the use of chemotherapy. A multivariate relative survival analysis was carried out.

Results: Diagnostic procedures have changed. Ultrasonography and computed tomography progressively have become the major diagnostic procedures. There was a slight improvement in stage: the proportion of stage I-II was 2.8% in the 1976-1980 period and 8.8% in the 2001-2005 period (P<0.001). There was a similar trend in the proportion of cases resected for cure, the corresponding percentages being 4.5 and 11.3%, respectively (P<0.001). The 5-year relative survival increased from 2.0 to 4.2% (P<0.001). In the multivariate relative survival analysis, the period remained a significant prognostic factor. Stage, sex, age and histology were independent prognostic factors.

Conclusion: Over a 30-year period, there were minor changes in the stage at diagnosis, resection for cure and prognosis of pancreatic cancers, although there were improvements in the diagnostic modalities. Pancreatic cancer still represents a major challenge in oncology.