V H Coupland1, J Konfortion2, R H Jack2, W Allum3, H M Kocher4, S P Riaz2, M Lüchtenborg5, H Møller6. 1. Public Health England, National Cancer Intelligence Network, London, UK. Electronic address: victoria.coupland@phe.gov.uk. 2. Public Health England, National Cancer Intelligence Network, London, UK. 3. The Royal Marsden NHS Foundation Trust, Department of Surgery, London, UK. 4. Centre for Tumour Biology, Barts Cancer Institute - a Cancer Research UK Centre of Excellence, Queen Mary University of London, London EC1M 6BQ, UK. 5. Public Health England, National Cancer Intelligence Network, London, UK; King's College London, Division of Cancer Studies, London, UK. 6. King's College London, Division of Cancer Studies, London, UK.
Abstract
OBJECTIVE: We assessed the association between population resection rates, hospital procedure volume and death rates in pancreatic cancer patients in England. DESIGN: Patients diagnosed with pancreatic cancer were identified from a linked cancer registration and Hospital Episode Statistics dataset. Cox regression analyses were used to assess all-cause mortality according to resection quintile and hospital volume, adjusting for sex, age, deprivation and comorbidity. RESULTS: There were 31,973 pancreatic cancer patients studied, 2580 had surgery. Increasing resection rates were associated with lower mortality among all patients (χ(2)(1df) = 176.18, ptrend < 0.001), with an unadjusted hazard ratio (HR) of 0.78 95%CI [0.75 to 0.81] in the highest versus the lowest resection quintile. Adjustment changed the estimate slightly (HR 0.82, 95%CI [0.79 to 0.85], (χ(2)(1df) = 99.44, ptrend < 0.001)). Among patients that underwent surgery, higher procedure volume was associated with lower mortality (HR = 0.88 95%CI [0.75-1.03] in hospitals carrying out 30+ versus <15 operations a year, shared frailty model, χ(2)(1df) = 1.82, ptrend = 0.177). CONCLUSION: Higher population resection rates were associated with lower mortality. The association with hospital procedure volume was less clear possibly due to small number of patients who underwent surgery. Nevertheless these results suggest survival is higher in hospitals that carry out a greater number of operations a year, particularly those doing 30+ operations, supporting the benefit of centralising perioperative expertise in specialist centres. Ensuring people are increasingly diagnosed when they are suitable candidates for surgery, and have access to these specialist centres may lead to an increase in the proportion of patients that undergo surgical resection which could plausibly increase survival of pancreatic cancer patients. Crown
OBJECTIVE: We assessed the association between population resection rates, hospital procedure volume and death rates in pancreatic cancerpatients in England. DESIGN:Patients diagnosed with pancreatic cancer were identified from a linked cancer registration and Hospital Episode Statistics dataset. Cox regression analyses were used to assess all-cause mortality according to resection quintile and hospital volume, adjusting for sex, age, deprivation and comorbidity. RESULTS: There were 31,973 pancreatic cancerpatients studied, 2580 had surgery. Increasing resection rates were associated with lower mortality among all patients (χ(2)(1df) = 176.18, ptrend < 0.001), with an unadjusted hazard ratio (HR) of 0.78 95%CI [0.75 to 0.81] in the highest versus the lowest resection quintile. Adjustment changed the estimate slightly (HR 0.82, 95%CI [0.79 to 0.85], (χ(2)(1df) = 99.44, ptrend < 0.001)). Among patients that underwent surgery, higher procedure volume was associated with lower mortality (HR = 0.88 95%CI [0.75-1.03] in hospitals carrying out 30+ versus <15 operations a year, shared frailty model, χ(2)(1df) = 1.82, ptrend = 0.177). CONCLUSION: Higher population resection rates were associated with lower mortality. The association with hospital procedure volume was less clear possibly due to small number of patients who underwent surgery. Nevertheless these results suggest survival is higher in hospitals that carry out a greater number of operations a year, particularly those doing 30+ operations, supporting the benefit of centralising perioperative expertise in specialist centres. Ensuring people are increasingly diagnosed when they are suitable candidates for surgery, and have access to these specialist centres may lead to an increase in the proportion of patients that undergo surgical resection which could plausibly increase survival of pancreatic cancerpatients. Crown
Authors: Yuan Chen; Shao-An Xue; Shahriar Behboudi; Goran H Mohammad; Stephen P Pereira; Emma C Morris Journal: Clin Cancer Res Date: 2017-07-14 Impact factor: 12.531
Authors: Martin Graversen; Sönke Detlefsen; Jon Kroll Bjerregaard; Per Pfeiffer; Michael Bau Mortensen Journal: Clin Exp Metastasis Date: 2017-05-17 Impact factor: 5.150