Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
Eur J Surg Oncol. 2022 Oct;48(10):2195-2201. doi: 10.1016/j.ejso.2022.05.031. Epub 2022 Jun 2.
Due to the centralization of pancreatic surgery, patients with suspected pancreatic cancer may undergo diagnostic workup in both a non-pancreatic centre and a pancreatic centre, i.e. multicentre workup. This retrospective study assessed whether multicentre diagnostic workup is associated with repeated diagnostics, delayed time-to-diagnosis, delayed time-to-treatment, survival and whether variation existed among pancreatic cancer networks.
This nationwide study included all patients diagnosed with non-metastatic pancreatic ductal adenocarcinoma (PDAC) in 2015, registered by the Netherlands Cancer Registry. A delayed time-to-diagnosis was defined as ≥3 weeks from initial hospital visit to final diagnosis. A delayed time-to-treatment was defined as ≥6 weeks from the first hospital visit to start of first tumour treatment. Multilevel logistic regression analyses and survival analyses were performed.
In total, 931 patients with non-metastatic PDAC were included. Overall, 175 patients (19%) underwent a multicentre diagnostic workup, which was significantly associated with repeated diagnostic investigations (OR = 6.31, 95% CI 4.13-9.64, P < 0.0001), a delayed time-to-diagnosis (OR = 2.66 95% CI 1.74-4.06, P < 0.001), and a delayed time-to-treatment (OR = 1.93 95% CI 1.12-3.31, P = 0.02), but not with decreased survival (HR = 1.09 95% CI 0.83-1.44; P = 0.532). Variation in outcomes per network was observed, especially for time-to-treatment, though the ICC was not statistically significant (P = 0.065).
Multicentre diagnostic workup for patients with PDAC is associated with repeated diagnostic investigations, a delayed time-to-diagnosis and delayed time-to-treatment compared to patients with monocentre workup. To reduce costs and improve treatment times, efforts should be made to improve network coordination, for example via network care pathways.
由于胰腺外科手术的集中化，疑似胰腺癌的患者可能需要在非胰腺中心和胰腺中心（即多中心检查）进行诊断性检查。本回顾性研究评估了多中心诊断性检查是否与重复诊断、诊断延迟、治疗延迟、生存有关，以及胰腺癌网络之间是否存在差异。
本研究纳入了 2015 年所有被荷兰癌症登记处登记的非转移性胰腺导管腺癌（PDAC）患者。诊断延迟时间定义为从首次就诊到最终诊断的时间≥3 周。治疗延迟时间定义为从首次就诊到开始首次肿瘤治疗的时间≥6 周。进行了多水平逻辑回归分析和生存分析。
共纳入 931 例非转移性 PDAC 患者。总体而言，175 例（19%）患者进行了多中心诊断性检查，与重复诊断检查显著相关（OR=6.31，95%CI 4.13-9.64，P<0.0001）、诊断延迟（OR=2.66，95%CI 1.74-4.06，P<0.001）和治疗延迟（OR=1.93，95%CI 1.12-3.31，P=0.02），但与生存时间缩短无关（HR=1.09，95%CI 0.83-1.44；P=0.532）。观察到每个网络的结果存在差异，特别是治疗时间，尽管 ICC 没有统计学意义（P=0.065）。
与单中心检查相比，多中心 PDAC 患者的诊断性检查与重复诊断检查、诊断延迟和治疗延迟有关。为了降低成本和提高治疗时间，应努力改善网络协调，例如通过网络护理途径。
