Centralisation of pancreatic cancer surgery led to increased resection rates and significantly better survival rates in high volume centres (Gooiker et al, Br J Surg 2014). Pancreas cancer care was centralised to two high volume cancer centres in Ireland since 2010. The National Cancer Registry (NCRI) is a publicly appointed body, established in 1991, to collect and classify information on all cancer cases which occur in Ireland. We analysed these data with the objective to examine the outcomes of pancreatic cancer care since the centralisation of pancreatic cancer surgery in Ireland.
Pancreatic cancer data have been collected by NCRI since 1994. Only those with stage 1 – 3 adenocarcinoma of the pancreas (PDAC) were included in the final analyses. Descriptive statistics, Pearson chi-square test and survival analysis using Kaplan Meier curve with log-rank test and cox regression was performed.
Between Jan 1994 and Dec 2013, of the 8230 patients with pancreatic cancer identified from the NCRI database, 4298 pts had histologically proven adenocarcinoma. Among these, 1177/27% of patients (pts) had stage 1 – 3 disease. 52% of these were male and 74% of pts were over 60 years of age. Stage 1, 2 and 3 disease comprised 25%, 32% and 42% of pts respectively. Overall 48 % of pts had surgery. Pre- and post-2010 resection rates increased from 44% to 49% (p = 0.14). 44% of pts had chemotherapy with significantly increased chemo utilisation post-2010, 39% vs 54% (p < 0.0005). 21% of pts had radiotherapy. Pre- and post- radiation rates were 19% versus 23% (p = 0.12) respectively. Overall survival (OS) for all pts were 9.0 mos (95% CI 8.1 – 9.9). This significantly improved post-centralisation of care, 8 mos to 14 mos, HR 0.67 (95% CI 0.58-0.78, p < 0.0005). In those who underwent resection, OS was 17 mos vs 25 mos pre- and post-2010, HR 0.66 (95% CI 0.51-0.84, p = 0.01). Among resected pts, 52% and 20% had chemo- and radio-therapy within the first year respectively. Also noted was that there were significantly fewer pts who received no treatment at all, 24% vs 35%, p < 0.0005.
Centralisation of PDAC surgery in Ireland has resulted in an improvement in utilisation rates of surgery, chemotherapy and radiotherapy leading to significantly improved overall survival for patients.
Clinical trial identification
Legal entity responsible for the study
Rozana Abdul Rahman and Ray McDermott.
Has not received any funding.
All authors have declared no conflicts of interest.