Raman spectroscopy with multivariate analysis: Characterization and classification of biomarkers of pancreatic cancer

Abstract

Aims: Since surgical resection is the only chance for longterm survival, determining the resectability of a pancreatic tumor is a crucial step. Although centralization for surgical expertise has improved the resection rates of pancreatic cancer in recent years, diagnostic work-up for M0pancreatic cancer patients is not centralized in the Netherlands. The current study investigated whether the hospital of initial diagnosis influenced the chance of undergoing surgery and the effect on survival. Methods: All patients diagnosed with M0-pancreatic cancer between 2005 and 2012 in The Netherlands were included. Population-based data were obtained from the nationwide Netherlands Cancer Registry. All 97 hospitals were classified as either «pancreatic center» or «nonpancreatic center», based on high-volume (>15/year) pancreatoduodenectomies performed in 2012. Groups were compared using chi-square tests. The relationship between diagnostic center and the chance of undergoing surgery was analysed by multivariable logistic regression. The influence of hospital of diagnosis on overall survival was assessed using multivariable Cox regression analysis. Results: Nineteen hospitals were designated as a pancreatic center (19.6%). Of the 7276 included patients, 2657 (36.5%) underwent surgery with a curative intent. This proportion was 50.6% of patients diagnosed in pancreatic centers and 29.6% for non-pancreatic centers. Actual resection was done in 41.3% for pancreatic centers and 23.0% for non-pancreatic centers. In multivariable analysis, patients diagnosed in a pancreatic center were more likely to undergo surgery with a curative intent (OR 2.26 95%CI 2.02e2.53). Diagnosis in a pancreatic center was associated with improved survival compared to diagnosis in a non-pancreatic center (HR 0.93; 95%CI 0.88e0.98). Conclusions: In this nationwide analysis, patients diagnosed with M0-pancreatic cancer in a pancreatic center were more likely to undergo a potentially curative resection and had better survival. This suggests that patients with M0-pancreatic cancer who are not referred for resection should undergo assessment by a specialized team.