The use of adjuvant chemotherapy for pancreatic cancer varies widely between hospitals: a nationwide population‐based analysis

• Published in: Cancer medicine (Malden, MA) Vol. 5; no. 10; pp. 2825 - 2831
• Main Authors: Bakens, Maikel J., Geest, Lydia G., Putten, Magreet, Laarhoven, Hanneke W., Creemers, Geert‐Jan, Besselink, Marc G., Lemmens, Valery E., Hingh, Ignace H.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.10.2016; John Wiley and Sons Inc
• Subjects: Adjuvant chemotherapy; Aged; Aged, 80 and over; Chemotherapy; Chemotherapy, Adjuvant - methods; Clinical Cancer Research; Disease-Free Survival; Female; Geriatrics; Hospitals; Humans; Logistic Models; Male; Medical prognosis; Middle Aged; Netherlands; Neuroendocrine tumors; Original Research; Pancreatic cancer; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy; Patients; Registries; Regression analysis; Statistical analysis; Studies; Surgery; Survival; Survival Analysis; treatment; Treatment Outcome; Netherlands; treatment; Adjuvant chemotherapy; pancreatic cancer
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.921

Adjuvant chemotherapy after pancreatoduodenectomy for pancreatic cancer is currently considered standard of care. In this nationwide study, we investigated which characteristics determine the likelihood of receiving adjuvant chemotherapy and its effect on overall survival. The data were obtained from the Netherlands Cancer Registry. All patients alive 90 days after pancreatoduodenectomy for M0‐pancreatic cancer between 2008 and 2013 in the Netherlands were included in this study. The likelihood to receive adjuvant chemotherapy was analyzed by multilevel logistic regression analysis and differences in time‐to‐first‐chemotherapy were tested for significance by Mann–Whitney U test. Overall survival was assessed by Kaplan–Meier method and Cox regression analysis. Of the 1195 patients undergoing a pancreatoduodenectomy for pancreatic cancer, 642 (54%) patients received adjuvant chemotherapy. Proportions differed significantly between the 19 pancreatic centers, ranging from 26% to 74% (P < 0.001). Median time‐to‐first‐chemotherapy was 6.7 weeks and did not differ between centers. Patients with a higher tumor stage, younger age, and diagnosed more recently were more likely to receive adjuvant treatment. The 5‐year overall survival was significantly prolonged in patients treated with adjuvant chemotherapy—23% versus 17%, log‐rank = 0.01. In Cox regression analysis, treatment with adjuvant chemotherapy significantly prolonged survival compared with treatment without adjuvant chemotherapy. The finding that elderly patients and patients with a low tumor stage are less likely to undergo treatment needs further attention, especially since adjuvant treatment is known to prolong survival in most of these patients. The use of adjuvant chemotherapy in the Netherlands significantly differed between pancreatic centers. Elderly patients and patients with TNM stage I disease were less likely to undergo adjuvant treatment. Adjuvant chemotherapy prolonged survival in this study.