pancreatic cancer ( pc ) is the fourth most common cause of cancer death in the usa , whereas in europe , it is the fourth for women and fifth for men.1,2 pc is the third most common cancer in the gastrointestinal tract after colorectal and esophagogastric cancer.2 the danish pancreatic cancer database ( dpcd ) aims to prospectively describe the epidemiology , diagnostic workup , histological or cytological diagnosis , treatment , and outcome of patients with pc in denmark at an institutional and national level . furthermore , dpcd collects data for continuous quality control of diagnostic workup and treatment . dpcd also provides baseline data for epidemiological research in pc . to ensure a high quality of the registered data , dpcd is organized as part of the danish pancreatic cancer group ( dpcg ) , a multidisciplinary group established for the publication of national guidelines and to promote research in the field of pc in denmark . the dpcd has included patients diagnosed with pancreatic ductal adenocarcinoma in denmark from may 1 , 2011 onward . only patients with a histological or cytological diagnosis are included . the total number of patients registered as of june 30 , 2014 , was 2,217 , corresponding to an average monthly inclusion rate of 58 patients . patients with pancreatic neoplasms other than ductal adenocarcinoma , eg , neuroendocrine tumors , are excluded . the data in the dpcd have been cross - referenced with the danish pathology registry and the danish national patient registry to ensure the completeness of registrations . lists of missing patients are distributed annually to the participating institutions in order to enter missing data . the completeness of the registry has gradually improved from 76% the first year ( 2011 ) to 83% in 2014 . from 2012 , patient age at diagnosis , tissue specimen for diagnosis ( ie , core needle biopsy , fine - needle aspirate , resection specimen ) , precise histological diagnosis , localization of the tumor , sex , and world health organization performance status at the time of diagnosis and/or start of treatment are registered . also the precise modalities used for the diagnostic workup , including imaging techniques , and the pretreatment tumor  node  metastasis stage , usually determined at the multidisciplinary team conference , are registered . the charlson comorbidity index can be calculated based on data from the national patient registry . the following treatment variables are included : type of operation , first adjuvant or neoadjuvant therapy , and first palliative chemo- or chemoradiation therapy . for patients treated by surgery , pathological staging and margin status are registered . the type of vascular resection , if any , has been registered since 2013 . baseline data of selected variables are shown in table 1 . in order to track and monitor the clinical pathway , several key data are registered , including the following dates : referral , end of diagnostic workup , multidisciplinary team conference , patients acceptance of treatment proposal , and first surgical and/or oncological treatment . table 2 shows the currently registered indicators that , due to dpcg , are the measurable key indicators of quality and desired timeline of workup and treatment initiation and fulfill the criteria setup by the danish government by law . the main end point is death , and the date of recurrence is not registered directly in the database . instead , dpcd relies on data from the danish civil registry to monitor the survival status of the study population , and this registration is virtually complete . the results with respect to baseline characteristics , key indicators , and survival ( table 2 ) are audited by all participating institutions and published annually . the data from dpcd are readily available to researchers , and all administrative regions in denmark ,  danske regioner [ danish regions ] have established standardized application forms for usage of data from all danish national health databases . data obtained from different national registries are coupled using the unique danish civil personal registration number . this coupling enables data from all registries , including dpcd , to be readily available for research studies.36 the treatment of pc in denmark has been centralized at four surgical centers and seven oncological departments , all of which contribute with data for the dpcd . the members of both dpcd and dpcg represent surgeons , oncologists , radiologists , and pathologists from the participating institutions . dpcd receives statistical , epidemiological , and data management support free of charge from danske regioner . most of the development and some of the registrations are based on good will from the involved clinicians . dpcd is currently undergoing a major revision , aiming at direct transfer of data from the national patient registry and the danish pathology registry , avoiding the need for manual registration by surgeons and oncologists . afterward , the study population also includes patients from whom it was not possible to obtain a cytological or histological diagnosis , in many cases due to early death . these patients , with a clinical pc diagnosis only , constitute 20% of all patients with pc in denmark and have a median overall survival as low as 1 month.79 hence , the overall survival of patients registered in dpcd is therefore expected to decrease . the four departments of pathology handling pancreatic resection specimens in denmark have from 2015 adopted a national , standardized protocol for pancreaticoduodenectomy specimen examination , involving multicolor inking of resection margins and specimen surfaces , axial slicing , and extensive tissue sampling.10 using this protocol , the rate of pancreaticoduodenectomy specimens with microscopic tumor - free margins ( r0 resections ) is expected to decrease . in the dpcd , data from patients with a histological diagnosis of ductal adenocarcinoma of the pancreas are included since may 1 , 2011 . moreover , data from patients with a histological diagnosis of periampullary and duodenal adenocarcinoma are included since 2012 . the total number of patients with pc registered as of june 30 , 2014 , was 2,217 , and the completeness of registration was 82% . dpcd supports continuous quality control assessment of diagnostic workup , treatment , and outcome and provides baseline data for basic , epidemiological , and clinical research projects in an unselected , geographically well - defined western population of patients with pc .
aim of databasethe danish pancreatic cancer database aims to prospectively register the epidemiology , diagnostic workup , diagnosis , treatment , and outcome of patients with pancreatic cancer in denmark at an institutional and national level.study populationsince may 1 , 2011 , all patients with microscopically verified ductal adenocarcinoma of the pancreas have been registered in the database . as of june 30 , 2014 , 
 the total number of patients registered was 2,217 . 
 all data are cross - referenced with the danish pathology registry and the danish patient registry to ensure the completeness of registrations.main variablesthe main registered variables are patient demographics , performance status , diagnostic workup , histological and/or cytological diagnosis , and clinical tumor stage . 
 the following data on treatment are registered : type of operation , date of first adjuvant , neoadjuvant , and first palliative chemo- or chemoradiation therapy , and dates for milestones in referrals , diagnostic workup , treatment decisions , and treatment . for patients undergoing resection , data on operative 
 evaluation of tumor stage , histological diagnosis , and duration of hospital stay are registered.descriptive datadeath is monitored using data from the danish civil registry . 
 this registry monitors the survival status of the danish population , and the registration is virtually complete . 
 all data in the database are audited by all participating institutions , with respect to baseline characteristics , key indicators , and survival . 
 the results are published annually.conclusionthe danish pancreatic cancer database has registered data on 2,217 patients with microscopically verified ductal adenocarcinoma of the pancreas . 
 the data have been obtained nationwide over a period of 4 years and 2 months . 
 the completeness of registration was 82% . 
 the observed overall 3-year survival after diagnosis was 6% .