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

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 Eu...

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Main Authors: Huang, Lei (Author) , Jansen, Lina (Author) , Balavarca, Yesilda (Author) , Babaei, Masoud (Author) , Becker, Nikolaus (Author) , Hackert, Thilo (Author) , Büchler, Markus W. (Author) , Schrotz-King, Petra (Author) , Brenner, Hermann (Author)
Format: Article (Journal)
Language:English
Published: 2019
In: Gut
Year: 2017, Volume: 68, Issue: 1, Pages: 130-139
ISSN:1468-3288
DOI:10.1136/gutjnl-2017-314828
Online Access:Verlag, Pay-per-use, Volltext: http://dx.doi.org/10.1136/gutjnl-2017-314828
Verlag, Pay-per-use, Volltext: https://gut.bmj.com/content/early/2017/11/20/gutjnl-2017-314828
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Author Notes: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 Grützmann, Susanne 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

MARC

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520 |a 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. 
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