Nationwide Improvement of Only Short-Term Survival After Resection for Pancreatic Cancer in The Netherlands
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. Pancreas
(Impact Factor: 2.96).
05/2012; 41(7):1063-6. DOI: 10.1097/MPA.0b013e31824c3dbf
Evaluation of incidence, treatment, and survival trends after resection of pancreatic cancer at a national level.
Using data on patient and tumor characteristics from the nationwide Netherlands Cancer Registry trends were analyzed for the period 1989-2008.
A total of 30,025 patients diagnosed with pancreatic cancer were included. The incidence remained stable over the 20-year study period at approximately 9 per 100,000 inhabitants. Resection rates increased from 8% in 1989 to 12% in 2008, adjuvant chemotherapy rates increased from 7% to 29%, and palliative chemotherapy rates increased from 5% to 19% (P < 0.0001 each). Relative survival proportions did not change over time; besides a minimal, nonsignificant increase at 3 months from 53% to 55%, these remained 34% at 6 months and 4.5% at 3 years. Among the patients undergoing tumor resection, relative survival increased from 82% to 93% at 3 months and from 51% to 63% at 1 year after diagnosis. However, no improvement was seen after 3 years (23%).
The increased short-term survival among patients who underwent resection probably reflects decreased postoperative mortality driven by ongoing centralization efforts. However, longer-term survival remained poor irrespective of the changes in management in the past decades.
Available from: Ignace H J T de Hingh
- "However, in this latter group of patients the rate of verification increased significantly over time from 45% to 57%. This can be partially explained by the increased resection rate after the introduction of high-volume centers in the Southern Netherlands  . Furthermore, the diagnostic advances that have been made in pancreatic cancer played an important role, especially the introduction of endoscopic ultrasonography (EUS) in the early nineties. "
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ABSTRACT: This population-based study assessed which factors were associated with pathological verification of pancreatic cancer.
All patients diagnosed with a malignancy of the pancreas between 1993 and 2010 in the South of the Netherlands (N=3321) were included.
Pancreatic cancer was pathologically verified in 59% of patients. The proportion of verification increased over time from 56% in 1993-1996 to 69% in 2009-2010 (p<0.0001). High rates of verification were found among young patients (<50 years vs. 60-69 yrs: adjusted odds ratio (ORadj) 3.2 (95% CI: 1.9-5.4)), patients with a high socioeconomic status (high vs. low: ORadj 1.3 (95% CI: 1.1-1.7)), patients with metastatic disease (metastatic vs locoregional: ORadj 3.2 (95% CI: 2.7-3.8)) and patients treated with chemotherapy (yes vs. no: ORadj 2.4 (95% CI: 1.8-3.2)). The most favorable prognosis was found in patients with verified locoregional disease (median overall survival (mOS) 7.6 months, 95% CI: 7.1-8.6). Patients with unverified metastatic disease carried the worst prognosis (mOS 1.7 months, 95% CI: 1.4-2.0).
Verification by pathology remains preferable and desirable whenever possible. However, the median survival rate exhibited by patients without verification suggests that the vast majority of patients suffered from true invasive pancreatic cancer. This may justify treatment decisions even in the absence of pathologic verification in selected patients.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Available from: wjgnet.com
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ABSTRACT: Pain in pancreatic cancer is often a major problem of treatment. Administration of opioids is frequently limited by side effects or insufficient analgesia. Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) represents an alternative for the palliative treatment of visceral pain in patients with pancreatic cancer. This review focuses on the indications, technique, outcomes of EUS-CPN and predictors of pain relief. EUS-CPN should be considered as the adjunct method to standard pain management. It moderately reduces pain in pancreatic cancer, without eliminating it. Nearly all patients need to continue opioid use, often at a constant dose. The effect on quality of life is controversial and survival is not influenced. The approach could be done in the central position of the celiac axis, which is easy to perform, or in the bilateral position of the celiac axis, with similar results in terms of pain alleviation. The EUS-CPN with multiple intraganglia injection approach seems to have better results, although extended studies are still needed. Further trials are required to enable more confident conclusions regarding timing, quantity of alcohol injected and the method of choice. Severe complications have rarely been reported, and great care should be taken in choosing the site of alcohol injection.
Available from: Reinhart Grundmann
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This overview comments on gender-specific differences in incidence, risk factors and prognosis in patients with carcinoma of the liver, gallbladder, extrahepatic bile duct and pancreas.
For the literature review, the MEDLINE database (PubMed) was searched under the key words "liver cancer", "gallbladder cancer", "extrahepatic bile duct carcinoma", "pancreatic cancer" AND "gender".
There were significant gender differences in the epidemiology of the analysed carcinomas. The incidence of hepatocellular carcinoma (HCC) is much higher in men than in women, one of 86 men, but only 1 out of 200 women develop a malignant primary liver tumour in Germany in the course of their life. The lifetime risk for carcinomas of the gallbladder and extrahepatic bile ducts in Germany amounts to about 0.6 % for women and 0.5 % for men, specifically gallbladder carcinomas are observed more frequently in women than in men. For pancreatic cancer, no clear gender preference exists in Germany, although the mortality risk for men is higher than that for women (age-adjusted standardised death rate in men 12.8/100, 000 persons, in women 9.5). Remarkable is furthermore the shift of the tumour incidence in the last decades. Liver cancer has increased among men in Germany by about 50 % in the last 30 years, the incidence of gallbladder carcinoma has inversely dropped. The prognosis of these cancers across all tumour stages is uniformly bad in an unselected patient population. This is probably the main reason why only little - if any - gender differences in survival are described.
In addition to avoiding the known risk factors such as hepatitis B and C virus infection, alcohol abuse, and smoking, the avoidance of overweight and obesity plays an increasingly important role in the prevention of these cancers.
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