Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.
Department of Gastrointestinal Surgery, Aarhus University Hospital, Aarhus, Denmark.
Acta Oncol. 2022 Mar;61(3):277-285. doi: 10.1080/0284186X.2021.2012252. Epub 2021 Dec 8.
Academic and high volume hospitals have better outcome for pancreatic cancer (PC) surgery, but there are no reports on oncological treatment. We aimed to determine the influence of facility types on overall survival (OS) after treatment with chemotherapy for inoperable PC.
2,657 patients were treated in Denmark from 2012 to 2018 and registered in the Danish Pancreatic Cancer Database. Facilities were classified as either secondary oncological units or comprehensive, tertiary referral cancer centers.
The average yearly number of patients seen at the four tertiary facilities was 71, and 31 at the four secondary facilities. Patients at secondary facilities were older, more frequently had severe comorbidity and lived in non-urban municipalities. As compared to combination chemotherapy, monotherapy with gemcitabine was used more often (59%) in secondary facilities than in tertiary (34%). The unadjusted median OS was 7.7 months at tertiary and 6.1 months at secondary facilities. The adjusted hazard ratio (HR) of 1.16 (confidence interval 1.07-1.27) demonstrated an excess risk of death for patients treated at secondary facilities, which disappeared when taking type of chemotherapy used into account. Hence, more use of combination chemotherapy was associated with the observed improved OS of patients treated at tertiary facilities. Declining HR's per year of first treatment indicated improved outcomes with time, however the difference among facility types remained significant.
Equal access to modern combination chemotherapy at all facilities on a national level is essential to ensure equality in treatment results.
学术型和高容量医院在胰腺癌（PC）手术方面的预后更好，但目前尚无关于肿瘤治疗的报道。我们旨在确定医疗机构类型对不可切除 PC 化疗后总生存期（OS）的影响。
2012 年至 2018 年，丹麦有 2657 名患者接受了治疗，并在丹麦胰腺癌数据库中进行了登记。医疗机构分为二级肿瘤单位或综合三级转诊癌症中心。
四家三级医院每年平均接诊患者 71 例，四家二级医院为 31 例。二级医院的患者年龄更大，合并症更严重，居住在非城市地区。与联合化疗相比，二级医院更常使用吉西他滨单药治疗（59%），而三级医院为 34%。三级医院的未调整中位 OS 为 7.7 个月，二级医院为 6.1 个月。调整后的危险比（HR）为 1.16（置信区间 1.07-1.27），表明二级医院治疗的患者死亡风险增加，但当考虑使用的化疗类型时，这种风险就消失了。因此，更多地使用联合化疗与在三级医院治疗的患者观察到的 OS 改善有关。每年首次治疗的 HR 下降表明随着时间的推移，结果有所改善，但不同医疗机构类型之间的差异仍然显著。
在国家层面上，所有医疗机构平等获得现代联合化疗对于确保治疗结果的平等至关重要。
