Race, Geography Associated With Resection Rates in Pancreatic Cancer

A retrospective cohort study showed that socioeconomic variables including race, marital status, insurance status, and geography are associated with rates of resection for early-stage pancreatic cancer. Most of these factors, however, were not associated with survival following resection.

Recent research has shown certain socioeconomic variables can predict poor outcome in pancreatic and other cancers. “The precise nature of the association between these variables and survival remains unclear,” wrote study authors led by Mia Shapiro, MD, of Harvard Medical School in Boston. “It is possible that these associations are due to differences in stage at presentation and receipt of treatment or are independently associated with outcome.”

The new study examined these variables in 17,530 patients with localized, non-metastatic pancreatic adenocarcinoma, based on the SEER database. Results were published online ahead of print in JAMA Surgery.

On a univariate analysis, many factors were associated with the likelihood of resection. For example, resection was more likely if patients were male (odds ratio [OR], 1.20 [95% confidence interval (CI), 1.13–1.27]), as well as if they were white (OR, 1.16 [95% CI, 1.08–1.26]). Non–African American race was also associated with higher likelihood of resection (OR for African American, 0.80 [95% CI, 0.73–0.88]), as was non-Hispanic ethnicity (OR for Hispanic, 0.83 [95% CI, 0.74–0.93]).

Being married was associated with a higher rate of resection (OR, 1.78 [95% CI, 1.67–1.89]), as was being located in the Northeast (OR, 1.62 [95% CI, 1.50–1.76]).

On multivariate analysis, several factors remained independently associated with resection. This included African American race (OR, 0.76 [95% CI, 0.65–0.88]; P < .001), Hispanic ethnicity (OR, 0.72 [95% CI, 0.60–0.85]; P < .001), and being married (OR, 1.42 [95% CI, 1.30–1.57]); P < .001). Living in the Northeast was also significantly associated with resection (OR, 1.67 [95% CI, 1.44–1.94]; P < .001), as was insurance status and tumor size.

Notably, the overall resection rate in the full cohort was 45.4%, and did not change over time. Resection was associated with a lower risk of disease-specific death, with a hazard ratio of 0.32 (95% CI, 0.31–0.33; P < .001). The median disease-specific survival of resected patients was 21 months, compared with 6 months for unresected patients.

The socioeconomic factors, however, were generally not independently associated with disease-specific survival. The only exception to this was geographic location: patients in the Southeast had the greatest likelihood of disease-specific death, and survival was longer in the Pacific West, the Northeast, and the Midwest.

The authors highlighted the differences in resection rates with regard to race. “The racial disparity in the utilization of resection represents an area for improvement in the care of patients with pancreatic cancer,” they wrote.

In an associated editorial, Daniel Anaya, MD, and Mokenge Malafa, MD, both of the H. Lee Moffitt Cancer Center in Tampa, Florida, wrote that efforts targeting the delivery of pancreatic cancer care are likely to have more impact in the short term than other interventions. The finding that there is significant regional variation is important. “Improving regionalization of pancreatic cancer care by increasing access to referral centers and standardizing evidence-based multidisciplinary care at these referring sites should be the focus of future interventions,” they wrote.