Background Treatment of cancer patients in certified cancer centers, that meet specific quality standards in term of structures and procedures of medical care, is a national treatment goal in Germany. However, convincing evidence that treatment in certified cancer centers is associated with better outcomes in patients with pancreatic cancer is still missing. Methods We used patient-specific information (demographic characteristics, diagnoses, treatments) from German statutory health insurance data covering the period 2009–2017 and hospital characteristics from the German Standardized Quality Reports. We investigated differences in survival between patients treated in hospitals with and without pancreatic cancer center certification by the German Cancer Society (GCS) using the Kaplan–Meier estimator and Cox regression with shared frailty. Results The final sample included 45,318 patients with pancreatic cancer treated in 1,051 hospitals (96 GCS-certified, 955 not GCS-certified). 5,426 (12.0%) of the patients were treated in GCS-certified pancreatic cancer centers. Patients treated in certified and non-certified hospitals had similar distributions of age, sex, and comorbidities. Median survival was 8.0 months in GCS-certified pancreatic cancer centers and 4.4 months in non-certified hospitals. Cox regression adjusting for multiple patient and hospital characteristics yielded a significantly lower hazard of long-term, all-cause mortality in patients treated in GCS-certified pancreatic centers (Hazard ratio = 0.89; 95%-CI = 0.85–0.93). This result remained robust in multiple sensitivity analyses, including stratified estimations for subgroups of patients and hospitals. Conclusion This robust observational evidence suggests that patients with pancreatic cancer benefit from treatment in a certified cancer center in terms of survival. Therefore, the certification of hospitals appears to be a powerful strategy to improve patient outcomes in pancreatic cancer care. Trial registration ClinicalTrials.gov (NCT04334239).

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Introduction: 2–8% of all gastric cancer occurs at a younger age, also known as early-onset gastric cancer (EOGC). The aim of the present work was to use clinical registry data to classify and characterize the young cohort of patients with gastric cancer more precisely. Methods: German Cancer Registry Group of the Society of German Tumor Centers—Network for Care, Quality and Research in Oncology (ADT)was queried for patients with gastric cancer from 2000–2016. An approach that stratified relative distributions of histological subtypes of gastric adenocarcinoma according to age percentiles was used to define and characterize EOGC. Demographics, tumor characteristics, treatment and survival were analyzed. Results: A total of 46,110 patients were included. Comparison of different groups of age with incidences of histological subtypes showed that incidence of signet ring cell carcinoma (SRCC) increased with decreasing age and exceeded pooled incidences of diffuse and intestinal type tumors in the youngest 20% of patients. We selected this group with median age of 53 as EOGC. The proportion of female patients was lower in EOGC than that of elderly patients (43% versus 45%; p < 0.001). EOGC presented more advanced and undifferentiated tumors with G3/4 stages in 77% versus 62%, T3/4 stages in 51% versus 48%, nodal positive tumors in 57% versus 53% and metastasis in 35% versus 30% (p < 0.001) and received less curative treatment (42% versus 52%; p < 0.001). Survival of EOGC was significantly better (five-years survival: 44% versus 31% (p < 0.0001), with age as independent predictor of better survival (HR 0.61; p < 0.0001). Conclusion: With this population-based registry study we were able to objectively define a cohort of patients referred to as EOGC. Despite more aggressive/advanced tumors and less curative treatment, survival was significantly better compared to elderly patients, and age was identified as an independent predictor for better survival.

Zusammenfassung Hintergrund Das vom Innovationsfonds geförderte Projekt „Wirksamkeit der Versorgung in onkologischen Zentren“ (WiZen) ist ein breit angelegtes Projekt zur Erforschung der Wirksamkeit von Zertifizierungen in der Onkologie. Im Rahmen des Projektes werden bundesweite Daten der AOKen und Daten Klinischer Krebsregister aus verschiedenen Bundesländern für die Jahre 2006–2017 verwendet. Zur Kombination der Stärken beider Datenquellen werden diese für acht verschiedene Krebsentitäten datenschutzkonform miteinander verknüpft. Methoden Das Datenlinkage erfolgte dabei anhand indirekter Identifikatoren und wurde mittels der Krankenversichertennummer als direktem Identifikator und Goldstandard validiert. Dies ermöglicht die Quantifizierung von Potenzial und Qualität verschiedener Linkage-Varianten. Als Kriterien zur Bewertung der Zuordnungen wurden Sensitivität und Spezifität sowie Treffergenauigkeit und Treffergüte genutzt. Die durch das Linkage resultierenden Verteilungen relevanter Variablen wurden anhand der ursprünglichen Verteilungen in den Einzeldatensätzen validiert. Ergebnisse Je nach Kombination indirekter Identifikatoren ergab sich eine Bandbreite von 22.125 bis 3.092.401 Linkage-Treffern. Eine nahezu perfekte Verknüpfung der betrachteten Daten konnte durch die Kombination von Informationen zu Entitätsart, Geburtsdatum, Geschlecht und Postleitzahl der Personen erreicht werden. Insgesamt wurden mit den genannten Merkmalen 74.586 eineindeutige Verknüpfungen und für die verschiedenen Entitäten eine mediane Treffergüte von mehr als 98% erreicht. Die Alters- und Geschlechtsverteilungen der verschiedenen Datenquellen sowie die verknüpften Sterbedaten wiesen zudem eine hohe Übereinstimmung auf. Diskussion und Schlussfolgerung GKV- und Krebsregisterdaten lassen sich mit hoher interner und externer Validität auf Individualdatenebene verknüpfen. Die stabile Verknüpfung ermöglicht durch den simultanen Zugang zu Variablen beider Datensätze („das Beste aus beiden Welten“) gänzlich neue Analysemöglichkeiten: Für einzelne Personen stehen nun sowohl Informationen zum UICC-Stadium der Erkrankung aus den Registern als auch Komorbiditäten aus den GKV-Daten zur Verfügung. Durch die Verwendung gut verfügbarer Linkagevariablen und den hohen Verknüpfungserfolg ist das Verfahren vielversprechend für künftige Linkages in der Versorgungsforschung.

Objective The available literature regarding outcome after pancreatic resection in locally advanced non-functional pNEN (LA-pNEN) is sparse. Therefore, this study evaluates the current survival outcomes and prognostic factors in after resection of LA-pNEN. Materials and methods This population-based analysis was derived from 17 German cancer registries from 2000 to 2019. Patients with upfront resected non-functional non-metastatic LA-pNEN were included. Results Out of 2776 patients with pNEN, 277 met the inclusion criteria. 137 (45%) of the patients were female. The median age was 63 ± 18 years. Lymph node metastasis was present in 45%. G1, G2 and G3 pNEN were found in 39%, 47% and 14% of the patients, respectively. Resection of LA-pNEN resulted in favorable 3-, 5- and 10-year overall survival of 79%, 74%, and 47%. Positive resection margin was the only potentially modifiable independent prognostic factor for overall survival (HR 1.93, 95% CI 1.71–3.69, p value = 0.046), whereas tumor grade G3 (HR 5.26, 95% CI 2.09–13.25, p value < 0.001) and lymphangiosis (HR 2.35, 95% CI 1.20–4.59, p value = 0.012) were the only independent prognostic factors for disease-free survival. Conclusion Resection of LA-pNEN is feasible and associated with favorable overall survival. G1 LA-pNEN with negative resection margins and absence of lymph node metastasis and lymphangiosis might be considered as cured, while those not fulfilling these criteria might be considered as a high-risk group for disease progression. Herein, negative resection margins represent the only potentially modifiable prognostic factor in LA-pNEN but seem to be influenced by tumor grade.