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.
- pancreatic cancer
- surgical resection
- TNM stage
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Contributors Conception or design: LH, LJ, YB, MB, PS-K, HB. Acquisition, analysis or interpretation of data: LH, LJ, YB, EM-M, M Babaei, LvdG, VL, LVE, HDS, TBJ, CWF, M Mortensen, MPŽ, VZ, NB, TH, M Mägi, TC, RS, RG, SM, AFG, M Bento, PH, GL, AS, M Moreau, TvvV, AB, MS, PM, VM, FXR, AC, XM, M Besselink, NM, M Büchler, PS-K, HB. Drafting of the manuscript: LH. Critical revision of the manuscript for important intellectual content: LH, LJ, YB, EM-M, M Babaei, LvdG, VL, LVE, HDS, TBJ, CWF, M Mortensen, MPŽ, VZ, NB, TH, M Mägi, TC, RS, RG, SM, AFG, M Bento, PH, GL, AS, M Moreau, TvvV, AB, MS, PM, VM, FXR, AC, XM, M Besselink, NM, M Büchler, PS-K, HB. Statistical analysis: LH, YB, EM-M (for PanGenS only). Administrative, technical or material support: M Büchler, PS-K, HB. Supervision: LJ, HB. All authors have given final approval of the manuscript for submission and publication.
Funding This study was partly supported by the German Cancer Aid (Deutsche Krebshilfe, #111365), European Cooperation in Science and Technology-COST Action (#BM1204: EUPancreas) and Fondo de Investigaciones Sanitarias (FIS), Instituto de Salud Carlos III-FEDER, Spain (#PI1501573).
Disclaimer The funders had no involvement in study design; in the collection, analysis or interpretation of data; in the writing of the report or in the decision to submit the paper for publication.
Competing interests None declared.
Ethics approval This study was approved by Ethics Committee of the Medical Faculty Heidelberg.
Provenance and peer review Not commissioned; externally peer reviewed.