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

Abstract

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.

Keywords: Adjuvant chemotherapy; pancreatic cancer; treatment.

Figure 1

Observed percentage of adjuvant chemotherapy treatment in pancreatic cancer patients undergoing pancreatoduodenectomy in pancreatic centers between 2008 and 2013 in the Netherlands.

Figure 2

Multilevel case‐mix adjusted probability for adjuvant chemotherapy treatment for pancreatic centers in the Netherlands between 2008 and 2013.

Figure 3

Kaplan–Meier, 5‐year overall survival adjuvant chemotherapy versus no adjuvant chemotherapy after pancreatoduodenectomy in pancreatic cancer patients in the Netherlands between 2008 and 2013.