Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2025; 17(8): 106447
Published online Aug 15, 2025. doi: 10.4251/wjgo.v17.i8.106447
Treatment options in patients with pancreatic cancer: A 10-year multicenter epidemiological investigation in China
Wan-Yi Sun, Shui-Sheng Zhang, Shao-Kai Zhang, Ren-Yi Qin, Bin Zhou, Jun Liu, Sheng-Ping Li, Ru-Fu Chen, Cheng-Feng Wang, Jin-Hu Fan
Wan-Yi Sun, Jin-Hu Fan, Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Shui-Sheng Zhang, Cheng-Feng Wang, Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Shao-Kai Zhang, Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 100021, Henan Province, China
Ren-Yi Qin, Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Bin Zhou, Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qingdao University, Qingdao 100021, Shandong Province, China
Jun Liu, Department of Hepatobiliary Surgery and Center of Organ Transplantation, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Sheng-Ping Li, Sun Yat-sen University Cancer Center, Guangzhou 100021, Guangdong Province, China
Ru-Fu Chen, Department of Hepatobiliary, Pancreatic and Splenic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
Co-first authors: Wan-Yi Sun and Shui-Sheng Zhang.
Co-corresponding authors: Cheng-Feng Wang and Jin-Hu Fan.
Author contributions: Sun WY and Zhang SS were responsible for writing the paper; Zhang SK, Qin RY, Zhou B, Liu J, Li SP, and Chen RF were in charge of patient information collection in different provinces; Wang CF supervised the research; Fan JH gave advice for article revision. Sun WY and Zhang SS contributed equally to this work as co-first authors. In this project, we have designated two corresponding authors, Professor Wang CF and Professor Fan JH, due to their unique and indispensable contributions to the research. Professor Wang CF is an expert in the Department of Pancreatic and Gastric Surgery at the Cancer Hospital. His extensive clinical experience and expertise are crucial for the design of the clinical aspects of this study. He is responsible for providing the treatment protocols related to surgical interventions, radiotherapy, chemotherapy, and other therapeutic approaches. Additionally, he offers professional background consultations to ensure that the clinical components of the study are scientifically sound and clinically relevant. Professor Fan JH is a professor in the Department of Epidemiology at the Cancer Hospital and a distinguished epidemiologist. His expertise was vital for the overall design of the study. He provided professional guidance on sample size calculations, questionnaire design, and statistical analyses. His contributions ensured that the research methodology is robust and that the study results were statistically valid and reliable. Given the critical roles that both Professor Wang and Professor Fan play in this project, their joint involvement as corresponding authors is essential. Their combined expertise ensured that the study is well-rounded, covering both the clinical and epidemiological aspects necessary for a comprehensive and successful research endeavor.
Institutional review board statement: The study adhered to the ethical principles outlined in the Declaration of Helsinki and received approval from the Ethics Committee of the Cancer Hospital of the Chinese Academy of Medical Sciences.
Informed consent statement: The study adhered to the ethical principles outlined in the Declaration of Helsinki and received approval from the Ethics Committee of the Cancer Hospital of the Chinese Academy of Medical Sciences. Due to the absence of potential harm to the enrolled patients, a waiver of informed consent was obtained.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The datasets generated and analyzed during this study are not publicly available due to privacy concerns, but are available from the corresponding author (Fan J.H., email: fanjh@cicams.ac.cn) upon reasonable request. Data access may require a completed data use agreement.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cheng-Feng Wang, Full Professor, Head, Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing 100021, China. wangchengfeng62@163.com
Received: February 26, 2025
Revised: April 28, 2025
Accepted: July 8, 2025
Published online: August 15, 2025
Processing time: 168 Days and 21.5 Hours
Abstract
BACKGROUND

The survival rate of pancreatic cancer is low, and there is a lack of effective treatment.

AIM

To explore the epidemiological characteristics of patients with pancreatic cancer in China and compare multiple chemotherapy regimens at different stages.

METHODS

This was a retrospective study conducted from 2005 to 2014, involving six cancer hospitals and eight general hospitals across seven geographical regions of China (East, South, North, Central, Southwest, Northwest, and Northeast). Stratified sampling was used based on the population distribution of each region. Efficacy assessments were conducted by Cox proportional hazards regression models. When assessing the effectiveness of various chemotherapy regimens, traditional drugs such as gemcitabine used as monotherapy served as the reference.

RESULTS

A total of 3256 patients were included. The median follow-up time was 407 days, and the median overall survival was 183 days. At diagnosis, 56% of patients were already in stage IV. Chemotherapy was administered to 39.73% of patients. In the adjuvant therapy phase, gemcitabine + fluorouracil was superior to gemcitabine monotherapy [hazard ratio (HR) = 0.35, 95% confidence interval (CI): 0.14-0.89]. In fluorouracil-based regimens, other combination regimens did not show effectiveness relative to monotherapy. For first-line treatment in patients with advanced disease, tegafur alone (HR = 0.20, 95%CI: 0.06-0.66), gemcitabine plus cisplatin (HR = 0.16, 95%CI: 0.04-0.70), and tegafur, gemcitabine plus platinum-based agents (HR = 0.32, 95%CI: 0.11-0.91) were associated with a lower risk of death compared to gemcitabine alone. In second-line treatment, there were no significant differences in efficacy among various drugs, but FOLFIRINOX (irinotecan + oxaliplatin + leucovorin + 5-fluorouracil) had an outstanding point estimate (HR = 0.10, 95%CI: 0.01-1.27).

CONCLUSION

In China, pancreatic cancer is often diagnosed at advanced stages, emphasizing the need for early diagnosis and treatment. Combined therapies in adjuvant and first-line settings may reduce the risk of death compared with monotherapy, and FOLFIRINOX might offer more significant benefits in second-line treatment.

Keywords: Pancreatic cancer; Epidemiology; Chemotherapy; Risk factors; Multicenter retrospective study

Core Tip: This study was based on 14 tertiary level A and oncology hospitals in seven major geographic regions in China. We included 3614 patients with pancreatic cancer over a 10-year period to compare the efficacy of different chemotherapy regimens and investigate the influence of risk factors and demographic characteristics on tumor prognosis.