Association of Treatment Inequity and Ancestry With Pancreatic Ductal Adenocarcinoma Survival

Heller, Danielle R.; Nicolson, Norman G.; Ahuja, Nita; Khan, Sajid; Kunstman, John W.

doi:10.1001/jamasurg.2019.5047

Cited by 50 publications

(57 citation statements)

References 28 publications

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“…When we explore the risk factor for survival rate, black people have a shorter survival time compared with other race, and the results have been demonstrated in many cancers [28][29][30], but the study found the black people have a better survival outcome when controlling for stage at the time of treatment [29]. Marital status has no difference in patient prognosis for pancreatic tumor, but some studies have reported the variable was a critical factor that could directly affect the clinical prognosis in other cancers [31,32].…”

Section: Discussionmentioning

confidence: 99%

Comparable prevalence of distant metastasis and survival of different primary site for LN + pancreatic tumor

Lou

Wei

et al. 2020

J Transl Med

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Background: Few studies have delved into the prevalence of distant metastasis (DM +) and survival for patients with lymph node metastases (LN +) by primary site. We aimed to detect differences in distant metastasis and prognosis between pancreatic head and bodytail tumors for LN + patients. Methods: Patients with chemotherapy, histologically diagnosed, primary site between 2004 and 2016 were included from the SEER (Surveillance, Epidemiology, and End Results) database. Pancreatic head tumors were compared with pancreatic bodytail tumors using the odds ratio (OR) for rates of distant metastasis, hazard ratios (HR) for overall survival (OS) and cancer-specific survival (CSS). The competing risk model and propensity score matching (PSM) were performed to further explore. Results: Of 5726 LN + patients identified from the SEER database, pancreatic head tumors account for 85.2% (4877 of 5726) and 14.8% (849 of 5726) were pancreatic bodytail tumors. The incidence of DM was lower in pancreatic head than in pancreatic bodytail tumors (OR, 0.29; 95% CI 0.23-0.37; P < 0.001). The multivariate Cox regression show pancreatic head tumors have a significantly shorter survival rate relative to pancreatic bodytail (HR, 1.12; 95% CI 1.03-1.22; P = 0.008), but the primary site was not a significant independent risk factor for prognosis by log-rank test (P = 0.39) and multivariate competing risk model [subdistribution HR (SHR), 1.08; 95% CI 0.98-1.19; P = 0.087].We then examined our conclusion by 1:1 propensity score matching, and the result reflected pancreatic head tumors have a lower risk of DM compared with pancreatic bodytail tumors (OR, 0.22; 95% CI 0.15-0.34; P < 0.001), but the primary site of pancreatic tumors was not associated with LN + patient survival based on univariate Cox regression (HR, 1.04; 95% CI 0.93-1.17; P = 0.435) and competing risk analysis (SHR, 1.01; 95% CI 0.89-1.12; P = 0.947). Conclusions: LN + pancreatic head tumors were significantly lower risk of DM relative to pancreatic bodytail tumors. Survival outcome in LN + pancreatic tumors didn't exist significant differences split by primary site, which indicates that the prognosis of LN + patients with chemotherapy isn't associated with the primary site of metastasis, but with the occurrence of metastasis.

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Section: Discussionmentioning

confidence: 99%

Comparable prevalence of distant metastasis and survival of different primary site for LN + pancreatic tumor

Lou

Wei

et al. 2020

J Transl Med

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“…14 While pancreatic cancer affects all populations in the United States, certain groups may bear a disproportionate burden of delayed cancer care compared with other groups. [15][16][17][18] For example, a larger proportion of minorities have traditionally presented with later-stage disease and, in turn, lower utilization of curative-intent therapy, and worse long-term outcomes. 19 Despite timeliness of care (i.e., the rapid initiation of treatment after definitive diagnosis) being a key component of high-quality cancer treatment, data on the topic have been somewhat scarce.…”

Section: Introductionmentioning

confidence: 99%

“…While pancreatic cancer affects all populations in the United States, certain groups may bear a disproportionate burden of delayed cancer care compared with other groups 15–18 . For example, a larger proportion of minorities have traditionally presented with later‐stage disease and, in turn, lower utilization of curative‐intent therapy, and worse long‐term outcomes 19 …”

Section: Introductionmentioning

confidence: 99%

Sex‐based differences in time to surgical care among pancreatic cancer patients: A national study of Medicare beneficiaries

Azap

Hyer

Díaz

et al. 2020

Journal of Surgical Oncology

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Introduction: The objective of this study was to characterize time from cancer symptoms to diagnosis and time from diagnosis to surgical treatment among patients undergoing pancreatectomy for cancer. Methods: Medicare beneficiaries who underwent pancreatectomy for cancer between 2013 and 2017 were identified using the 100% Medicare Inpatient Standard Analytic Files. Mixed effects negative binomial regression models were utilized to determine which factors were associated with the number of weeks to diagnosis and pancreatic resection. Results: Among 7647 Medicare beneficiaries, two-thirds (n = 5127, 67%) had symptoms associated with a pancreatic cancer diagnosis before surgery. Median time from the first symptom to diagnosis was 6 weeks (IQR: 1-25) and the median time from diagnosis to surgery was 4 weeks (IQR: 2-15). In risk-adjusted models, female patients had 13% longer waiting times from identification of a related symptom to pancreatic cancer diagnosis (OR = 1.13, 95% CI: 1.05-1.21) and 12% longer waiting times from diagnosis to surgery (OR = 1.12, 95% CI: 1.07-1.18). Older age was associated with 10% longer waiting times from symptom identification to diagnosis (p < .0001). Conclusions: Female and older patients had longer wait times between symptom presentation and pancreatic cancer diagnosis. Sex-based disparities in cancer care need to be recognized and addressed by policymakers and health care institutions.

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“…A number of studies have investigated the underlying etiologies of racial disparities in pancreatic cancer survival. It has been proposed that socioeconomic factors such as health insurance status, access to high‐volume cancer centers, referral to multi‐disciplinary cancer care, and refusal of indicated treatment may contribute to worse long‐term outcomes among Black patients 14,39,40,44,44,45 . In a recent study of over 280,000 patients with resected pancreatic cancer identified within the NCDB, Black race was associated with overall worse survival.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies have also demonstrated that Black patients with pancreatic cancer are less likely to undergo surgical resection regardless of cancer stage, especially when presenting to low‐volume, non‐National Cancer Institute/National Comprehensive Cancer Network‐designated cancer care hospitals. In addition, Black patients are less likely to receive perioperative multimodality therapy 8–20 …”

Section: Introductionmentioning

confidence: 99%

Thirty‐day complication rates do not differ by race among patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma

Mitsakos

Dennis

Parikh

et al. 2021

Journal of Surgical Oncology

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Background and Objectives Black patients with pancreatic ductal adenocarcinoma (PDAC) are less likely to receive multimodality treatment and have worse survival compared to White patients. However, little is known regarding racial differences in postoperative outcomes. The primary aim of this study was to determine if 30‐day complication rates following pancreaticoduodenectomy (PD) differ by race. Methods A retrospective cohort study of patients who underwent PD for PDAC from 2014 to 2016 within the ACS‐NSQIP pancreatectomy‐specific data set was performed. Primary outcomes were 30‐day pancreas‐specific and overall major complications. Results A total of 6936 patients were identified, including 91.4% (N = 6337) White and 8.6% (N = 599) Black. Pathologic stage and rates of neoadjuvant therapy were similar among Whites and Blacks. Rates of pancreas‐specific (23.9% vs. 23.1%, p = .88) and major postoperative complications (39.2% vs. 39.9%, p = .55) were similar between Whites and Blacks. By multivariable regression analysis, there was no association between race and odds of pancreas‐specific complications (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.89–1.37) or overall major complications (OR 1.13, 95% CI 0.95–1.36). Conclusions Among patients undergoing PD for PDAC, Black race is not associated with increased pancreas‐specific or overall 30‐day postoperative complications. Short‐term postoperative outcomes do not appear to explain the increase in pancreatic cancer mortality among Black patients.

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Association of Treatment Inequity and Ancestry With Pancreatic Ductal Adenocarcinoma Survival

Cited by 50 publications

References 28 publications

Comparable prevalence of distant metastasis and survival of different primary site for LN + pancreatic tumor

Comparable prevalence of distant metastasis and survival of different primary site for LN + pancreatic tumor

Sex‐based differences in time to surgical care among pancreatic cancer patients: A national study of Medicare beneficiaries

Thirty‐day complication rates do not differ by race among patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma

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