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

Lei Huang, Lina Jansen*, Yesilda Balavarca, Esther Molina-Montes, Masoud Babaei, Lydia van der Geest, Valery Lemmens, Liesbet Van Eycken, Harlinde De Schutter, Tom B Johannesen, Claus W Fristrup, Michael B Mortensen, Maja Primic-Žakelj, Vesna Zadnik, Nikolaus Becker, Thilo Hackert, Margit Mägi, Tiziana Cassetti, Romano Sassatelli, Robert GrützmannSusanne Merkel, Ana F Gonçalves, Maria J Bento, Péter Hegyi, Gábor Lakatos, Andrea Szentesi, Michel Moreau, Tony van de Velde, Annegien Broeks, Milena Sant, Pamela Minicozzi, Vincenzo Mazzaferro, Francisco X Real, Alfredo Carrato, Xavier Molero, Marc G Besselink, Núria Malats, Markus W Büchler, Petra Schrotz-King, Hermann Brenner

*Corresponding author for this work

    Research output: Contribution to journalJournal articleResearchpeer-review

    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.

    Original languageEnglish
    JournalGut
    Volume68
    Issue number1
    Pages (from-to)130-139
    ISSN0017-5749
    DOIs
    Publication statusPublished - 1. Jan 2019

    Bibliographical note

    © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

    Keywords

    • TNM stage
    • age
    • pancreatic cancer
    • population-based
    • surgical resection
    • variation
    • Practice Patterns, Physicians'/statistics & numerical data
    • SEER Program
    • Europe
    • Humans
    • Middle Aged
    • Male
    • Pancreatic Neoplasms/epidemiology
    • United States/epidemiology
    • Survival Analysis
    • Aged, 80 and over
    • Adult
    • Female
    • Registries
    • Aged
    • Neoplasm Staging

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