Impact of Microscopic Confirmation on Therapeutic Management of Pancreatic Cancer Patients: Lessons from an Italian Regional Tumor Registry

SIMPLE SUMMARY: In consideration of poor survival and rising incidence of pancreatic cancer (PC), the impact of microscopic diagnosis of PC (MiDPC) turns out to be crucial in therapeutic choice. Clinical and oncological data regarding all cases of PC in the Veneto region (Italy) from 1987 were extracted from the Veneto cancer registry. The percentage of MiDPC was 60% in 2018. MiDPC was higher among patients <75 years old (84.4%) compared to those ≥75 years old (38.9%). Patients with MiDPC had higher 5-year survival than patients with no MiDPC (12.9% vs. 1.2%, p < 0.001). Considering the evidence regarding the impact of histopathological parameters on PC patient selection and tailored treatment approaches, 41% of PCs in the Veneto region are still not histologically proven, with a consequent impact on the choice of the correct treatment strategy and, thus, survival. In light of the increasing incidence of the disease, its mortality, and its heterogeneity, all efforts should be aimed to optimize diagnostic–therapeutic pathways, encouraging MiDPC. ABSTRACT: Background: Incidence of pancreatic cancer (PC) is increasing worldwide and is set to become the second leading cause of cancer-related death in 2040 with a poor 5-year overall survival (OS). The aim of this study was to analyze the impact of microscopic diagnosis of PC (MiDPC) on diagnostic–therapeutic management and outcome. Methods: The Veneto region (north-eastern Italy) has been covered by a cancer registry (CR) since 1987. Clinical and oncological data about all cases of PC in the Veneto region from 1987 were extracted from the Veneto CR database. Results: In 2018, 1340 incident cases of PC in the Veneto population were registered (4.1% of all malignant tumors), with an increasing trend in females and stable incidence in males. Five-year OS in patients with PC was 8%. The percentage of MiDPC increased from 44% in 2010 to 60% in 2018 (p = 0.001). MiDPC was higher among patients aged < 75 years old (84.4%) compared to those aged ≥75 years old (38.9%), p = 0.001. Between 2010 and 2018, a significant increase in biopsy on the primary neoplasm (24.9% vs. 13%, p < 0.001) was reported. Patients with MiDPC had higher 5-year survival than patients with no MiDPC (12.9% vs. 1.2%, p < 0.001). Conclusions: The implementation of MiDPC was essential to improve diagnostic–therapeutic pathways and consequently the survival of PC patients.