Racial Disparity in Pancreatoduodenectomy for Borderline Resectable Pancreatic Adenocarcinoma
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 T...
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| Veröffentlicht in: | Annals of surgical oncology 2021-02, Vol.28 (2), p.1088-1096 |
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| creator | Molina, George Clancy, Thomas E. Tsai, Thomas C. Lam, Miranda Wang, Jiping |
| description | 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
|
| doi_str_mv | 10.1245/s10434-020-08717-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2476736076</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2476736076</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-3ef4898a8964fef08c941490ee6b83aa17274009bb28888a12aca334ae08d6ae3</originalsourceid><addsrcrecordid>eNp9kE1LAzEQhoMotlb_gAdZ8LyabLJJ9ljrJxSUokcJs9lZ2dJuarIL7b832lpv5jJh5pl34CHknNErlon8OjAquEhpRlOqFVPp-oAMWR5bQmp2GP9U6rTIZD4gJyHMKWWK0_yYDHjsMVnkQ_I-A9vAIrltwgp8022Spk1eoLUeoXNV7yps0XZuuUlq55Mb5yv0i6bFZIYhDqBc4J5vbDKOvLPgbdO6JZySoxoWAc92dUTe7u9eJ4_p9PnhaTKepparvEs51kIXGnQhRY011bYQTBQUUZaaAzCVKUFpUZaZjg9YBhY4F4BUVxKQj8jlNnfl3WePoTNz1_s2njSZUFJxSZWMVLalrHcheKzNyjdL8BvDqPk2arZGTTRqfoyadVy62EX35RKr_cqvwgjwLRDiqP1A_3f7n9gvIJ-CmQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2476736076</pqid></control><display><type>article</type><title>Racial Disparity in Pancreatoduodenectomy for Borderline Resectable Pancreatic Adenocarcinoma</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Molina, George ; Clancy, Thomas E. ; Tsai, Thomas C. ; Lam, Miranda ; Wang, Jiping</creator><creatorcontrib>Molina, George ; Clancy, Thomas E. ; Tsai, Thomas C. ; Lam, Miranda ; Wang, Jiping</creatorcontrib><description>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.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-020-08717-x</identifier><identifier>PMID: 32651695</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adenocarcinoma ; Adenocarcinoma - surgery ; Aged ; Female ; Humans ; Inequality ; Male ; Medicine ; Medicine & Public Health ; Metastases ; Middle Aged ; Neoadjuvant Therapy ; Oncology ; Pancreas ; Pancreatectomy ; Pancreatic cancer ; Pancreatic Neoplasms - surgery ; Pancreatic Tumors ; Pancreaticoduodenectomy ; Patients ; Racial differences ; Regression analysis ; Retrospective Studies ; Surgery ; Surgical Oncology ; Treatment Outcome</subject><ispartof>Annals of surgical oncology, 2021-02, Vol.28 (2), p.1088-1096</ispartof><rights>Society of Surgical Oncology 2020</rights><rights>Society of Surgical Oncology 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-3ef4898a8964fef08c941490ee6b83aa17274009bb28888a12aca334ae08d6ae3</citedby><cites>FETCH-LOGICAL-c375t-3ef4898a8964fef08c941490ee6b83aa17274009bb28888a12aca334ae08d6ae3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-020-08717-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-020-08717-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32651695$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Molina, George</creatorcontrib><creatorcontrib>Clancy, Thomas E.</creatorcontrib><creatorcontrib>Tsai, Thomas C.</creatorcontrib><creatorcontrib>Lam, Miranda</creatorcontrib><creatorcontrib>Wang, Jiping</creatorcontrib><title>Racial Disparity in Pancreatoduodenectomy for Borderline Resectable Pancreatic Adenocarcinoma</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>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.</description><subject>Adenocarcinoma</subject><subject>Adenocarcinoma - surgery</subject><subject>Aged</subject><subject>Female</subject><subject>Humans</subject><subject>Inequality</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy</subject><subject>Oncology</subject><subject>Pancreas</subject><subject>Pancreatectomy</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreatic Tumors</subject><subject>Pancreaticoduodenectomy</subject><subject>Patients</subject><subject>Racial differences</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Treatment Outcome</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kE1LAzEQhoMotlb_gAdZ8LyabLJJ9ljrJxSUokcJs9lZ2dJuarIL7b832lpv5jJh5pl34CHknNErlon8OjAquEhpRlOqFVPp-oAMWR5bQmp2GP9U6rTIZD4gJyHMKWWK0_yYDHjsMVnkQ_I-A9vAIrltwgp8022Spk1eoLUeoXNV7yps0XZuuUlq55Mb5yv0i6bFZIYhDqBc4J5vbDKOvLPgbdO6JZySoxoWAc92dUTe7u9eJ4_p9PnhaTKepparvEs51kIXGnQhRY011bYQTBQUUZaaAzCVKUFpUZaZjg9YBhY4F4BUVxKQj8jlNnfl3WePoTNz1_s2njSZUFJxSZWMVLalrHcheKzNyjdL8BvDqPk2arZGTTRqfoyadVy62EX35RKr_cqvwgjwLRDiqP1A_3f7n9gvIJ-CmQ</recordid><startdate>20210201</startdate><enddate>20210201</enddate><creator>Molina, George</creator><creator>Clancy, Thomas E.</creator><creator>Tsai, Thomas C.</creator><creator>Lam, Miranda</creator><creator>Wang, Jiping</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20210201</creationdate><title>Racial Disparity in Pancreatoduodenectomy for Borderline Resectable Pancreatic Adenocarcinoma</title><author>Molina, George ; Clancy, Thomas E. ; Tsai, Thomas C. ; Lam, Miranda ; Wang, Jiping</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-3ef4898a8964fef08c941490ee6b83aa17274009bb28888a12aca334ae08d6ae3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adenocarcinoma</topic><topic>Adenocarcinoma - surgery</topic><topic>Aged</topic><topic>Female</topic><topic>Humans</topic><topic>Inequality</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy</topic><topic>Oncology</topic><topic>Pancreas</topic><topic>Pancreatectomy</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreatic Tumors</topic><topic>Pancreaticoduodenectomy</topic><topic>Patients</topic><topic>Racial differences</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Molina, George</creatorcontrib><creatorcontrib>Clancy, Thomas E.</creatorcontrib><creatorcontrib>Tsai, Thomas C.</creatorcontrib><creatorcontrib>Lam, Miranda</creatorcontrib><creatorcontrib>Wang, Jiping</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Molina, George</au><au>Clancy, Thomas E.</au><au>Tsai, Thomas C.</au><au>Lam, Miranda</au><au>Wang, Jiping</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Racial Disparity in Pancreatoduodenectomy for Borderline Resectable Pancreatic Adenocarcinoma</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2021-02-01</date><risdate>2021</risdate><volume>28</volume><issue>2</issue><spage>1088</spage><epage>1096</epage><pages>1088-1096</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>32651695</pmid><doi>10.1245/s10434-020-08717-x</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2021-02, Vol.28 (2), p.1088-1096 |
| issn | 1068-9265 1534-4681 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Adenocarcinoma Adenocarcinoma - surgery Aged Female Humans Inequality Male Medicine Medicine & Public Health Metastases Middle Aged Neoadjuvant Therapy Oncology Pancreas Pancreatectomy Pancreatic cancer Pancreatic Neoplasms - surgery Pancreatic Tumors Pancreaticoduodenectomy Patients Racial differences Regression analysis Retrospective Studies Surgery Surgical Oncology Treatment Outcome |
| title | Racial Disparity in Pancreatoduodenectomy for Borderline Resectable Pancreatic Adenocarcinoma |
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