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Racial Disparity in Pancreatoduodenectomy for Borderline Resectable Pancreatic Adenocarcinoma

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Previous studies have found racial disparity in pancreatectomies for resectable pancreatic adenocarcinoma. The aim of this study was to investigate if racial disparities were worse in the performance of pancreaticoduodenectomy for borderline resectable pancreatic adenocarcinoma.

Methods

This study used the National Cancer Database (2004–2016) and included patients with non-metastatic and head of the pancreas borderline resectable pancreatic adenocarcinoma. Multivariable, Poisson regression models with robust standard errors evaluated the relative risk (RR) of undergoing a pancreaticoduodenectomy among non-White patients (Black, Asian, and non-White Hispanic) compared with White patients. A Poisson regression model with hospital fixed effects was performed to evaluate if findings were due to within-hospital or between-hospital variation. Interaction between race and neoadjuvant therapy was also evaluated.

Results

There were 15,482 patients (median age 68 years, interquartile range 60–76 years; 48.6% male) with borderline resectable pancreatic adenocarcinoma who were predominantly White (84.3%, n = 13,058; non-White, 15.7%, n = 2424). Overall, 18.4% (n = 2853) had a pancreatic resection. Non-White patients had a significantly lower likelihood of undergoing a pancreatic resection for borderline resectable pancreatic adenocarcinoma when compared with White patients (RR 0.75, 95% confidence interval 0.68–0.83; p < 0.001). These findings persisted in the hospital fixed-effects model. In the interaction analysis, there were no significant differences in the likelihood of pancreatic resection if patients received neoadjuvant therapy.

Conclusions

Non-White patients were 25% less likely to undergo a pancreatic resection for borderline resectable pancreatic adenocarcinoma compared with White patients. This racial disparity was due to variation in care within-hospitals and disappeared if non-White patients were treated with neoadjuvant therapy.

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Acknowledgments

The NCDB is a joint project of the CoC of the American College of Surgeons and the American Cancer Society. The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the CoC have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA

    George Molina MD, MPH, Thomas E. Clancy MD & Jiping Wang MD, PhD

  2. Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    George Molina MD, MPH, Thomas E. Clancy MD, Miranda Lam MD, MBA & Jiping Wang MD, PhD

  3. Division of General and Gastrointestinal Surgery, Department of Surgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA

    Thomas C. Tsai MD, MPH

  4. Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA, USA

    Miranda Lam MD, MBA

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George Molina, Thomas E. Clancy, Thomas Tsai, Miranda Lam, and Jiping Wang have no disclosures to report.

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Correspondence to Jiping Wang MD, PhD.

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Molina, G., Clancy, T.E., Tsai, T.C. et al. Racial Disparity in Pancreatoduodenectomy for Borderline Resectable Pancreatic Adenocarcinoma. Ann Surg Oncol 28, 1088–1096 (2021). https://doi.org/10.1245/s10434-020-08717-x

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  • DOI: https://doi.org/10.1245/s10434-020-08717-x

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