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Gut. 2019 Jan;68(1):130-139. doi: 10.1136/gutjnl-2017-314828. Epub 2017 Nov 20.

Resection of pancreatic cancer in Europe and USA: an international large-scale study highlighting large variations.

Author information

1
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
2
German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
3
Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.
4
Geneticand Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), CIBERONC, ISCIII, Madrid, Spain.
5
Netherlands Cancer Registry (NCR), Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands.
6
Belgian Cancer Registry (BCR), Brussels, Belgium.
7
Registry Department, The Cancer Registry of Norway (CRN), Oslo, Norway.
8
Danish Pancreatic Cancer Database (DPCD), Odense, Denmark.
9
Danish Pancreatic Cancer Group, HPB Section, Department of Surgery, Odense University Hospital, Odense, Denmark.
10
Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
11
Clinical Cancer Registry, DKFZ and NCT, Heidelberg, Germany.
12
Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
13
Estonian Cancer Registry, National Institute for Health Development, Tallinn, Estonia.
14
Pancreatic Cancer Registry of Reggio Emilia Province, Unit of Gastroenterology and Digestive Endoscopy AUSL-RE, Local Health Authority-IRCCS, Reggio Emilia, Italy.
15
Department of Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
16
Departments of Epidemiology, Portuguese Oncology Institute of Porto (IPOP), Porto, Portugal.
17
Institute for Translational Medicine, University of Pécs, Pécs, Hungary.
18
Department of Oncology, St. Istvan and St. Laszlo Hospital and Out-Patient Department, Budapest, Hungary.
19
Department of Surgical Oncology, Jules Bordet Institute (IJB), Brussels, Belgium.
20
Biometrics Department, The Netherlands Cancer Institute (NKI), Amsterdam, Netherlands.
21
Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS, Istituto Nazionale dei Tumori (INT), Milan, Italy.
22
Hepato-Biliary Surgery Unit, Istituto Nazionale dei Tumori (INT), and University of Milan, Milan, Italy.
23
Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), CIBERONC, Madrid, Spain.
24
Department de Ciencies Experimentals i de la, Universitat Pompeu Fabra, Barcelona, Spain.
25
Department of Oncology, Ramon y Cajal University Hospital, IRYCIS, Alcala University, CIBERONC, Madrid, Spain.
26
Hospital Universitari Vall d'Hebron, Exocrine Pancreas Research Unit and Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Campus de la UAB, Barcelona, Spain.
27
CIBEREHD and CIBERESP, Madrid, Spain.
28
Dutch Pancreatic Cancer Group, Academic Medical Centre Amsterdam, Amsterdam, Netherlands.

Abstract

OBJECTIVE:

Resection can potentially cure resectable pancreatic cancer (PaC) and significantly prolong survival in some patients. This large-scale international study aimed to investigate variations in resection for PaC in Europe and USA and determinants for its utilisation.

DESIGN:

Data from six European population-based cancer registries and the US Surveillance, Epidemiology, and End Results Program database during 2003-2016 were analysed. Age-standardised resection rates for overall and stage I-II PaCs were computed. Associations between resection and demographic and clinical parameters were assessed using multivariable logistic regression models.

RESULTS:

A total of 153 698 records were analysed. In population-based registries in 2012-2014, resection rates ranged from 13.2% (Estonia) to 21.2% (Slovenia) overall and from 34.8% (Norway) to 68.7% (Denmark) for stage I-II tumours, with great international variations. During 2003-2014, resection rates only increased in USA, the Netherlands and Denmark. Resection was significantly less frequently performed with more advanced tumour stage (ORs for stage III and IV versus stage I-II tumours: 0.05-0.18 and 0.01-0.06 across countries) and increasing age (ORs for patients 70-79 and ≥80 versus those <60 years: 0.37-0.63 and 0.03-0.16 across countries). Patients with advanced-stage tumours (stage III-IV: 63.8%-81.2%) and at older ages (≥70 years: 52.6%-59.5%) receiving less frequently resection comprised the majority of diagnosed cases. Patient performance status, tumour location and size were also associated with resection application.

CONCLUSION:

Rates of PaC resection remain low in Europe and USA with great international variations. Further studies are warranted to explore reasons for these variations.

KEYWORDS:

TNM stage; age; pancreatic cancer; population-based; surgical resection; variation

PMID:
29158237
DOI:
10.1136/gutjnl-2017-314828
[Indexed for MEDLINE]

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