Abstract
Background: Pancreatic neoplasms consist of exocrine, endocrine and benign tumors. Exocrine pancreatic cancer is the fourth leading cause of cancer-related death in the US. Racial disparities in incidence, diagnosis, treatment, and outcomes have been evaluated in different types of tumors, but the data on pancreatic neoplasms are lacking. Our aim is to evaluate the racial disparities in clinical characteristics and survival of patients with pancreatic neoplasms.
Methods: Using the National Cancer Database (NCDB), we identified 340,780 patients diagnosed with a pancreatic neoplasm between 2004 and 2015. Simple descriptive statistics were created for all covariates. Chi-square analysis was used to examine the distribution of demographic and clinicopathologic variables among different races. Survival analysis was done on patients with either death dates or follow-up dates, totaling 305,576 patients. Kaplan Meier survival analysis was used for unadjusted results, and Cox proportional hazards model was used for multivariable analysis. Races were grouped into White, Black, Hispanic, and others. The objective of the study is to assess racial disparities in clinical presentation, and to evaluate whether this influences the outcomes in patients with pancreatic neoplasms.
Results: The median age at diagnosis was 69 (range 18-90) years and 50.6% were males. Carcinoma was the most common histology (81.3%), followed by other histology (9.6%), benign (5.4%) and neuroendocrine (3.7%) tumors. The percent of White, Black, Hispanic, and other race was 74.5, 11.3, 5.0, and 9.1%. Whites presented at more advanced ages compared to Blacks, Hispanics, and others (78.3, 68.6, 69.3, 76.3% were ≥60 years at diagnosis; p<0.0001). Blacks and Hispanics presented more frequently with advanced stage (III and IV) of the disease compared to Whites (54.7, 52.8, 50.9%; p<0.0001). Uninsured patients had a higher risk of death compared to those with insurance, HR=1.11 [95% CI 1.09-1.14]. Patients with lower annual income had a higher hazard of death (one example: <$38,000 vs >$63,000 HR=1.20 [95% CI 1.19-1.22]). Unadjusted analysis showed Blacks had a marginally higher hazard of death than Whites, HR=1.02 [95% CI 1.01-1.03]. However, after adjustment for age, sex, histology, grade, comorbidity score, income, education, and year of diagnosis, Blacks and Hispanics had a slightly better overall survival than Whites, HR=0.96 [95% CI 0.94-0.97] and 0.85 [95% CI 0.84-0.87]. Among patients with treatment information, time to first treatment was significantly longer among Blacks and Hispanics compared to Whites (4.4 and 3.2 days longer on average, p<0.0001).
Conclusion: Our study provides evidence that various disparities exist across different races in pancreatic neoplasms. However, they did not lead to inferior outcomes in minorities. Our findings should be examined in other cohorts where more data about treatment are available.
Citation Format: Hussein Assi, Michael Machiorlatti, Sara Vesely, Vipul Pareek, Hassan Hatoum, Sarbajit Mukherjee. Racial disparities in clinical characteristics and outcomes of patients with pancreatic neoplasms: An eleven-year analysis of the National Cancer Database (NCDB) [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C086.
