title: Volume matters in the systemic treatment of metastatic pancreatic cancer: a population-based study in the Netherlands.
abstract: OBJECTIVE
  In pancreatic surgery, a relation between surgical volume and postoperative mortality and overall survival (OS) has been recognized, with high-volume centers reporting significantly better survival rates. We aimed to explore the influence of hospital volume on administration of palliative chemotherapy and OS in the Netherlands.
  
  
  METHODS
  Patients diagnosed between 2007 and 2011 with metastatic pancreatic cancer were identified in the Netherlands Cancer Registry. Three types of high-volume centers were defined: high-volume (1) incidence center, based on the number of patients diagnosed with metastatic pancreatic cancer, (2) treatment center based on number of patients with metastatic pancreatic cancer who started treatment with palliative chemotherapy and (3) surgical center based on the number of resections with curative intent for pancreatic cancer. Independent predictors of administration of palliative chemotherapy were evaluated by means of logistic regression analysis. The multivariable Cox proportional hazard model was used to assess the impact of being diagnosed or treated in high-volume centers on survival.
  
  
  RESULTS
  A total of 5385 patients presented with metastatic pancreatic cancer of which 24 % received palliative chemotherapy. Being treated with chemotherapy in a high-volume chemotherapy treatment center was associated with improved survival (HR 0.76, 95 % CI 0.67-0.87). Also, in all patients with metastatic pancreatic cancer, being diagnosed in a high-volume surgical center was associated with improved survival (HR 0.74, 95 % CI 0.66-0.83).
  
  
  CONCLUSIONS
  Hospital volume of palliative chemotherapy for metastatic pancreatic cancer was associated with improved survival, demonstrating that a volume-outcome relationship, as described for pancreatic surgery, may also exist for pancreatic medical oncology.
authors.affiliation: Department of Medical Oncology, Academic Medical Center, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands. n.hajmohammad@amc.nl.
authors.forename: N
authors.initials: N
authors.lastname: Haj Mohammad
authors.affiliation: Department of Medical Oncology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.|Department of Research, Comprehensive Cancer Organisation The Netherlands/Netherlands Cancer Registry, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Bernards
authors.affiliation: Department of Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
authors.forename: M G H
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: Department of Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
authors.forename: O R
authors.initials: OR
authors.lastname: Busch
authors.affiliation: Department of Medical Oncology, Academic Medical Center, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Wilmink
authors.affiliation: Department of Medical Oncology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
authors.forename: G J M
authors.initials: GJ
authors.lastname: Creemers
authors.affiliation: Department of Surgical Oncology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
authors.forename: I H J T
authors.initials: IH
authors.lastname: De Hingh
authors.affiliation: Department of Research, Comprehensive Cancer Organisation The Netherlands/Netherlands Cancer Registry, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.|Department of Public Health, Erasmus Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
authors.forename: V E P P
authors.initials: VE
authors.lastname: Lemmens
authors.affiliation: Department of Medical Oncology, Academic Medical Center, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
authors.forename: H W M
authors.initials: HW
authors.lastname: van Laarhoven
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009426:Netherlands / Q000453:epidemiology; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D012042:Registries
keywords: High-volume hospital; Palliative chemotherapy; Pancreatic cancer; Population based; Survival