Racial disparities in pancreatic resection and survival among elderly patients: A SEER database analysis.

Abstract

e16784 Background: For localized pancreatic cancer treatment, surgical resection is the only potentially curative option. Currently, little is known about whether racial disparities exist in elderly patients’ access to resection and outcomes after resection. This study aims to understand the relationship between race/ethnicity and both resection rate and survival after surgery in elderly patients. Methods: The analysis included patients aged ≥65 years diagnosed with locoregional resectable (stage I and II according to the 6th AJCC TNM staging system) pancreatic cancer between 2007 and 2016 in the Surveillance, Epidemiology, and End Results database. Patients without complete surgical or survival data were excluded from the analysis. Multiple logistic regression was used to assess the association between race/ethnicity and receipt of resection. The effect of resection on 6-month and 5-year overall survival (OS) was evaluated using multivariate Cox proportional hazards regression, controlling for other clinical and demographic factors, such as sex, age, martial status, residence region, tumor location, tumor size, and year of diagnosis. Results: Of 12,829 patients, 4,310 (46.0%) received resection and 5,062 (54.0%) did not. Median follow-up among resected patients was 16 months (1-60 months), and 6-month and 5-year OS was 62.83% and 4.54%, respectively. The majority of the patients were white (73.1%), followed by Hispanic (9.3%), black (9.1%), and other (American Indian, Asian/Pacific Islander) (8.6%). Black (OR 0.69; 95%CI 0.60-0.80) and Hispanic patients (OR 0.78; 95%CI 0.68-0.90) were less likely to receive resection compared to white patients. While Hispanic patients had worse 6-month OS compared to white patients (HR 1.43; 95%CI 1.19-1.72), 5-year OS was not significantly different across the racial/ethnic groups. Other factors significantly worsened 5-year OS were being age 75 years or older, living in South region, and having tumor size greater than 50mm. Conclusions: Our findings support that racial disparities exist in resection rate in elderly populations. However, no racial difference was seen in the long-term survival after pancreatic resection. This may suggest that improving the access to resection for minorities with pancreatic cancer may improve their health outcomes. [Table: see text]