HPB : the official journal of the International Hepato Pancreato Biliary Association · 2025
Regional variation for tumour-directed treatment and survival in patients with pancreatic adenocarcinoma: a nationwide population-based analysis.
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Broekman Thijmen H T, Augustinus Simone, Biesma Nanske, Bonsing Bert A, Cirkel Geert A, de Hingh Ignace H J T, Homs Marjolein Y V, van Hooft Jeanin E, van der Kolk B Marion M, de Meijer Vincent E, van Santvoort Hjalmar, de Vos-Geelen Judith, Wumkes Miriam L, Besselink Marc G, Wilmink J Hanneke W, van der Geest Lydia G, Dutch Pancreatic Cancer Group
Аннотация
BACKGROUND: In the Netherlands, cancer care is increasingly organised within oncology networks involving multiple hospitals. This nationwide population-based study aims to assess variation between oncology networks for pancreatic adenocarcinoma (PAC).
METHOD: Patients with PAC (2015-2020) were included from the Netherlands Cancer Registry and assigned to eight oncology networks based on first hospital visit. Multilevel multivariable logistic and survival regression models were used.
RESULTS: Among 16,130 patients with PAC, tumour-directed treatment was applied in 40 % (range 35 %-44 % across regions), resection in 15 % (12 %-19 %), and chemotherapy in 33 % (29 %-37 %) of patients. Casemix also varied significantly between regions. Compared to the grand mean, the probability to undergo resection was higher in one region (odds ratio [OR] = 1.25, 95 % confidence interval [CI] 1.07-1.45) and lower in another (OR = 0.70, 95%CI: 0.56-0.87). Chemotherapy use followed similar patterns (OR = 1.21, 95%CI 1.06-1.38, and OR = 0.81, 95%CI 0.72-0.92). Median overall survival was 3.7 months (range 3.4-4.3; log-rank p < 0.001), multivariable multilevel analysis revealed no significant survival differences (p = 0.245).
CONCLUSION: Although the likelihood of receiving chemotherapy and resection for patients with PAC varied between Dutch oncology networks, no clinical meaningful survival differences were found after case-mix adjustment. Concerningly, the majority of patients with PAC do not receive any tumour-directed treatment.
METHOD: Patients with PAC (2015-2020) were included from the Netherlands Cancer Registry and assigned to eight oncology networks based on first hospital visit. Multilevel multivariable logistic and survival regression models were used.
RESULTS: Among 16,130 patients with PAC, tumour-directed treatment was applied in 40 % (range 35 %-44 % across regions), resection in 15 % (12 %-19 %), and chemotherapy in 33 % (29 %-37 %) of patients. Casemix also varied significantly between regions. Compared to the grand mean, the probability to undergo resection was higher in one region (odds ratio [OR] = 1.25, 95 % confidence interval [CI] 1.07-1.45) and lower in another (OR = 0.70, 95%CI: 0.56-0.87). Chemotherapy use followed similar patterns (OR = 1.21, 95%CI 1.06-1.38, and OR = 0.81, 95%CI 0.72-0.92). Median overall survival was 3.7 months (range 3.4-4.3; log-rank p < 0.001), multivariable multilevel analysis revealed no significant survival differences (p = 0.245).
CONCLUSION: Although the likelihood of receiving chemotherapy and resection for patients with PAC varied between Dutch oncology networks, no clinical meaningful survival differences were found after case-mix adjustment. Concerningly, the majority of patients with PAC do not receive any tumour-directed treatment.