The Impact of Socioeconomic Status, Surgical Resection and Type of Hospital on Survival in Patients with Pancreatic Cancer:A Population-Based Study in The Netherlands

The influence of socioeconomic inequalities in pancreatic cancer patients and especially its effect in patients who had a resection is not known. Hospital type in which resection is performed might also influence outcome. Patients diagnosed with pancreatic cancer from 1989 to 2011 (n = 34,757) were selected from the population-based Netherlands Cancer Registry. Postal code was used to determine SES. Multivariable survival analyses using Cox regression were conducted to discriminate independent risk factors for death. Patients living in a high SES neighborhood more often underwent resection and more often were operated in a university hospital. After adjustment for clinicopathological factors, risk of dying was increased independently for patients with intermediate and low SES compared to patients with high SES. After resection, no survival difference was found among patients in the three SES groups. However, survival was better for patients treated in university hospitals compared to patients treated in non-university hospitals. Low SES was an independent risk factor for poor survival in patients with pancreatic cancer. SES was not an adverse risk factor after resection. Resection in non-university hospitals was associated with a worse prognosis.</p

Univariable and multivariable analysis of variables in relation to Hazard Ratio (HR) of pancreatic cancer patients in the Netherlands, period 1989–2011 (n = 34,757).

<p>Univariable and multivariable analysis of variables in relation to Hazard Ratio (HR) of pancreatic cancer patients in the Netherlands, period 1989–2011 (n = 34,757).</p

Distribution of individual characteristics of patients with pancreatic cancer in the Netherlands across different socioeconomic groups. (n = 34,757).

<p>Distribution of individual characteristics of patients with pancreatic cancer in the Netherlands across different socioeconomic groups. (n = 34,757).</p

Results of pancreaticoduodenectomy in patients with periampullary adenocarcinoma - Perineural growth more important prognostic factor than tumor localization

Objective: To study the impact of perineural growth as a prognostic factor in periampullary adenocarcinorna (pancreatic head, ampulla of Vater, distal bile duct, and duodenal carcinoma). Summary Background Data: Pancreatic head carcinoma is considered to have the worst prognosis of the periampullary carcinomas. Several other prognostic factors for periampullary tumors have been identified, eg, lyrnph node status, free resection margins, tumor size and differentiation, and vascular invasion. The impact of perineural growth as a prognostic factor in relation to the site of origin of periampullary carcinomas is unknown. Methods: Data of 205 patients with periampullary carcinomas were retrieved from our prospective database. Pancreaticoduodenectomy was performed in 121 patients. Their clinicopathological data were reviewed and analyzed in a multivariate analysis. Results: Perineural growth was present in 49% of the cases (37 of the 5 1 patients with pancreatic head carcinoma; 7 of the 30 patients with ampulla of Vater carcinoma; 7 of the 19 with distal bile duct carcinoma,- and 8 of the 21 with duodenal carcinoma). Overall 5-year survival was 32.6% with a median survival of 20.7 months. Median Survival in tumors with perineural growth was 13.1 months compared with 36.0 months in tumors without perineural growth (P <0.0001) Using multivariate analysis, the following unfavorable prognostic factors were identified: perineural growth (RR = 2.90, 95% CI 1.62-5.22), nonradical resection (RR = 2.28, 95% Cl 1.19-4.36), positive lymph nodes (RR = 1.96, 95% CI 1. 11-3.45), and angioinvasion (RR = 1.79, 95% CI 1.05-3.06). Portal or superior mesenteric vein reconstruction and tumor localization were not of statistical significance. Conclusion: Perineural growth is a more important risk factor for survival than the primary site of periampullary carcinomas