Pancreatic resection: a key component to reducing racial disparities in pancreatic adenocarcinoma
Department of Surgery
Adenocarcinoma; *African Americans; Aged; *European Continental Ancestry Group; Female; *Healthcare Disparities; Humans; Male; Middle Aged; Pancreatectomy; Pancreatic Neoplasms; Retrospective Studies; SEER Program; Treatment Refusal
BACKGROUND: Blacks are affected disproportionately by pancreatic adenocarcinoma and have been linked with poor survival. Surgical resection remains the only potential curative option. If surgical disparities exist, then they may provide insight into outcome discrepancies.
METHODS: Patients with pancreatic adenocarcinoma were identified using the National Cancer Institute's Surveillance, Epidemiology, and End Results data from 1992 to 2002. Univariate analyses were used to compare demographics, tumor characteristics, and surgical data; and logistic regression was used to determine independent predictors for recommendation/performance of surgery. Kaplan-Meier survival was assessed, and a Cox proportional hazards model was used to examine adjusted predictors of survival.
RESULTS: In total, 27,828 patients were identified; 81.4% were white, 11.5% were black, 7.2% were of other race. White patients and black patients presented with similar stage and had surgery recommended at similar rates (34.5% vs 34%, respectively; P = .57). Black patients underwent fewer resections (10.6% vs 12.7%; P < .001). Multivariate analysis confirmed that black patients were less likely to undergo resection (adjusted odds ratio, 0.69; 95% confidence interval [95% CI], 0.57-0.84). Overall, black patients had worse univariate survival. The survival among black patients who underwent resection did not differ statistically from the survival of similar white patients, although the median survival trended lower (11 months vs 13 months; P = .13). In a multivariate Cox model, black race predicted worse survival (hazards ratio, 1.11; 95% CI, 1.07-1.16), and pancreatic resection was protective (hazards ratio, 0.56; 95% CI, 0.53-0.59).
CONCLUSIONS: Black and white patients with pancreatic adenocarcinoma presented with similar stages and were recommended for pancreatectomy at similar rates, yet black patients underwent fewer resections. After resection, crude survival did not differ significantly between white and black patients, although multivariate analysis demonstrated a survival disadvantage for blacks despite adjusting for resection. The current results suggested that pancreatectomy may be underused for blacks. Maximizing resection rates for appropriate patients may be an important component in reducing outcome disparities for pancreatic adenocarcinoma.
DOI of Published Version
Cancer. 2009 Sep 1;115(17):3979-90. Link to article on publisher's site
Murphy, Melissa M.; Simons, Jessica P.; Hill, Joshua S.; McDade, Theodore P.; Ng, Sing Chau; Whalen, Giles F.; Shah, Shimul A.; Harrison, Lynn H. Jr.; and Tseng, Jennifer F., "Pancreatic resection: a key component to reducing racial disparities in pancreatic adenocarcinoma" (2009). Surgery Publications and Presentations. 57.