Abstract
PurposeIn pancreatic surgery, a relation between surgical volume and postoperative mortality and overall survival (OS) has been recognized, with high-volume centers reporting significantly better survival rates. We aimed to explore the influence of hospital volume on administration of palliative chemotherapy and OS in the Netherlands.MethodsPatients diagnosed between 2007 and 2011 with metastatic pancreatic cancer were identified in the Netherlands Cancer Registry. Three types of high-volume centers were defined: high-volume (1) incidence center, based on the number of patients diagnosed with metastatic pancreatic cancer, (2) treatment center based on number of patients with metastatic pancreatic cancer who started treatment with palliative chemotherapy and (3) surgical center based on the number of resections with curative intent for pancreatic cancer. Independent predictors of administration of palliative chemotherapy were evaluated by means of logistic regression analysis. The multivariable Cox proportional hazard model was used to assess the impact of being diagnosed or treated in high-volume centers on survival.ResultsA total of 5385 patients presented with metastatic pancreatic cancer of which 24 % received palliative chemotherapy. Being treated with chemotherapy in a high-volume chemotherapy treatment center was associated with improved survival (HR 0.76, 95 % CI 0.67–0.87). Also, in all patients with metastatic pancreatic cancer, being diagnosed in a high-volume surgical center was associated with improved survival (HR 0.74, 95 % CI 0.66–0.83).ConclusionsHospital volume of palliative chemotherapy for metastatic pancreatic cancer was associated with improved survival, demonstrating that a volume–outcome relationship, as described for pancreatic surgery, may also exist for pancreatic medical oncology.Electronic supplementary materialThe online version of this article (doi:10.1007/s00432-016-2140-5) contains supplementary material, which is available to authorized users.
Highlights
The incidence of pancreatic cancer is rising in developed countries
Between January 1, 2007, and December 31, 2011, 9981 patients were diagnosed with pancreatic cancer in the Netherlands, of whom 5385 (54 %) patients presented with metastatic disease
To the best of our knowledge, this is the first study showing a positive correlation between hospital volume and overall survival in patients with metastatic pancreatic cancer
Summary
The incidence of pancreatic cancer is rising in developed countries. In 2012 alone, 104,481 individuals died from pancreatic cancer making it the fifth leading cause of cancer death with the worst overall survival (European Cancer Observatory 2012). By 2030, pancreatic cancer is projected to become the second leading cause of cancer-related death (Rahib et al 2014). The only potentially curative treatment for pancreatic cancer is surgical resection. Only about 20 % of the patients present with resectable disease. J Cancer Res Clin Oncol (2016) 142:1353–1360
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