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Amin K, Khan H, Hearld LR, Chu DI, Prete V, Mehari KR, Heslin MJ, Fonseca AL. Association between Rural Residence and Processes of Care in Pancreatic Cancer Treatment. J Gastrointest Surg 2023; 27:2155-2165. [PMID: 37553515 PMCID: PMC10731615 DOI: 10.1007/s11605-023-05764-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/17/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Pancreatic adenocarcinoma (PDAC) is an aggressive malignancy associated with poor outcomes. Surgical resection and receipt of multimodal therapy have been shown to improve outcomes in patients with potentially resectable PDAC; however treatment and outcome disparities persist on many fronts. The aim of this study was to analyze the relationship between rural residence and receipt of quality cancer care in patients diagnosed with non-metastatic PDAC. METHODS Using the National Cancer Database, patients with non-metastatic pancreatic cancer were identified from 2006-2016. Patients were classified as living in metropolitan, urban, or rural areas. Multivariable logistic regression was used to identify predictors of cancer treatment and survival. RESULTS A total of 41,786 patients were identified: 81.6% metropolitan, 16.2% urban, and 2.2% rural. Rural residing patients were less likely to receive curative-intent surgery (p = 0.037) and multimodal therapy (p < 0.001) compared to their metropolitan and urban counterparts. On logistic regression analysis, rural residence was independently associated with decreased surgical resection [OR 0.82; CI 95% 0.69-0.99; p = 0.039] and multimodal therapy [OR 0.70; CI 95% 0.38-0.97; p = 0.047]. Rural residence independently predicted decreased overall survival [OR 1.64; CI 95% 1.45-1.93; p < 0.001] for all patients that were analyzed. In the cohort of patients who underwent surgical resection, rural residence did not independently predict overall survival [OR 0.97; CI 95% 0.85-1.11; p = 0.652]. CONCLUSIONS Rural residence impacts receipt of optimal cancer care in patients with non-metastatic PDAC but does not predict overall survival in patients who receive curative-intent treatment.
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Affiliation(s)
- Krisha Amin
- Department of Surgery, The University of South Alabama, 2451 USA Medical Center Drive, Mastin, 705, Mobile, AL, 36617, USA
| | - Hamza Khan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Larry R Hearld
- Department of Health Services Administration, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel I Chu
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victoria Prete
- Department of Surgery, The University of South Alabama, 2451 USA Medical Center Drive, Mastin, 705, Mobile, AL, 36617, USA
| | - Krista R Mehari
- Department of Psychology, The University of South Alabama, Mobile, AL, USA
| | - Martin J Heslin
- Department of Surgery, The University of South Alabama, 2451 USA Medical Center Drive, Mastin, 705, Mobile, AL, 36617, USA
| | - Annabelle L Fonseca
- Department of Surgery, The University of South Alabama, 2451 USA Medical Center Drive, Mastin, 705, Mobile, AL, 36617, USA.
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Iliesiu A, Toma RV, Ciongariu AM, Costea R, Zarnescu N, Bîlteanu L. A pancreatic adenocarcinoma mimicking hepatoid carcinoma of uncertain histogenesis: A case report and literature review. Oncol Lett 2023; 26:442. [PMID: 37720666 PMCID: PMC10502951 DOI: 10.3892/ol.2023.14029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 06/19/2023] [Indexed: 09/19/2023] Open
Abstract
In rare cases, metastatic adenocarcinomas of different origin may exhibit the features of hepatoid carcinoma (HC), a rare malignant epithelial tumor, most commonly occurring in the ovaries and stomach, as well as in the pancreas and biliary ducts. A case of a 72-year-old female patient who developed a highly aggressive, poorly differentiated pancreatic ductal adenocarcinoma with peritoneal carcinomatosis, demonstrating hepatoid differentiation upon conventional hematoxylin and eosin staining is reported in the present study. The patient presented with severe abdominal pain, and the radiological investigations performed revealed ovarian and hepatic tumor masses and peritoneal lesions, which were surgically removed. The gross examination of the peritoneum and omentum revealed multiple solid, firm, grey-white nodules, diffusely infiltrating the adipose tissue. The microscopic examination revealed a malignant epithelial proliferation, composed of polygonal cells with abundant eosinophilic cytoplasm and irregular, pleomorphic nuclei. Certain cells presented with intracytoplasmic mucus inclusions, raising suspicion of a HC with an uncertain histogenesis. Immunohistochemical staining was performed, and the tumor cells were found to be positive for cytokeratin (CK)7, CK18 and mucin 5AC, whereas negative staining for CK20, caudal-type homeobox transcription factor 2, α-fetoprotein, paired box gene 8, GATA-binding protein 3 and Wilms tumor 1 were documented. Thus, the diagnosis of metastatic pancreatic adenocarcinoma was established. The main aim of the present study was to provide further knowledge concerning poorly differentiated metastatic adenocarcinoma resembling HC, emphasizing the histopathological and immunohistochemical features of these malignant lesions and raising awareness of the diagnostic difficulties that may arise, as well as the importance of the use immunohistochemistry in differentiating carcinomas of uncertain histogenesis.
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Affiliation(s)
- Andreea Iliesiu
- Department of Pathology, University Emergency Hospital of Bucharest, Bucharest 014461, Romania
- Faculty of General Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 050474, Romania
| | - Radu-Valeriu Toma
- Faculty of General Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 050474, Romania
- Oncological Institute ‘Alexandru Trestioreanu’, Bucharest 022328, Romania
| | - Ana Maria Ciongariu
- Department of Pathology, University Emergency Hospital of Bucharest, Bucharest 014461, Romania
- Faculty of General Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 050474, Romania
| | - Radu Costea
- Faculty of General Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 050474, Romania
- Second Department of Surgery, University Emergency Hospital of Bucharest, Bucharest 050098, Romania
| | - Narcis Zarnescu
- Faculty of General Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 050474, Romania
- Second Department of Surgery, University Emergency Hospital of Bucharest, Bucharest 050098, Romania
| | - Liviu Bîlteanu
- Oncological Institute ‘Alexandru Trestioreanu’, Bucharest 022328, Romania
- Department of Preclinical Sciences, Faculty of Veterinary Medicine, University of Agronomic Sciences and Veterinary Medicine, Bucharest 050097, Romania
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Thobie A, Bouvier AM, Bouvier V, Jooste V, Queneherve L, Nousbaum JB, Alves A, Dejardin O. Survival variability across hospitals after resection for pancreatic adenocarcinoma: A multilevel survival analysis on a high-resolution population-based study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1450-1456. [PMID: 37055280 DOI: 10.1016/j.ejso.2023.03.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/23/2023] [Accepted: 03/24/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION Resection is the cornerstone of curative management for pancreatic ductal adenocarcinoma (PDAC). Hospital surgical volume influence post-operative mortality. Few is known about impact on survival. METHODS Population included 763 patients resected for PDAC within the 4 French digestive tumor registries between 2000 and 2014. Spline method was used to determine annual surgical volume thresholds influencing survival. A multilevel survival regression model was used to study center effect. RESULTS Population was divided into three groups: low-volume (LVC) (<41 hepatobiliary/pancreatic procedures/year), medium-volume (MVC) (41-233) and high-volume centers (HVC) (>233). Patients in LVC were older (p = 0.02), had a lower rate of disease-free margins (76.7% vs. 77.2% and 69.5%, p = 0.028) and a higher post-operative mortality than in MVC and HVC (12.5% and 7.5% vs. 2.2%; p = 0.004). Median survival was higher in HVC than in other centers (25 vs. 15.2 months, p < 0.0001). Survival variance attributable to center effect accounted for 3.7% of total variance. In multilevel survival analysis, surgical volume explained the inter-hospital survival heterogeneity (non-significant variance after adding the volume to the model p = 0.3). Patients resected in HVC had a better survival than in LVC (HR 0.64 [0.50-0.82], p < 0.0001). There was no difference between MVC and HVC. CONCLUSION Regarding center effect, individual characteristics had little impact on survival variability across hospitals. Hospital volume was a major contributor to the center effect. Given the difficulty of centralizing pancreatic surgery, it would be wise to determine which factors would indicate management in a HVC.
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Affiliation(s)
- Alexandre Thobie
- Department of Digestive Surgery, Hospital of Avranches-Granville, Avranches, France; UMR INSERM 1086 'ANTICIPE', Centre François Baclesse, Caen, France.
| | - Anne-Marie Bouvier
- Registre des cancers digestifs de Bourgogne, University Hospital of Dijon, Dijon, France; INSERM UMR 1231, University of Burgundy, Dijon, France
| | - Véronique Bouvier
- UMR INSERM 1086 'ANTICIPE', Centre François Baclesse, Caen, France; Registre des cancers digestifs du Calvados, University Hospital of Caen, Caen, France; Department of Research, Epidemiology Research and Evaluation Unit, University Hospital of Caen, Caen, France
| | - Valérie Jooste
- Registre des cancers digestifs de Bourgogne, University Hospital of Dijon, Dijon, France; INSERM UMR 1231, University of Burgundy, Dijon, France
| | - Lucille Queneherve
- Registre des cancers digestifs du Finistère, University Hospital of Brest, Brest, France; EA7479 SPURBO, University of Western Brittany, Brest, France
| | - Jean-Baptiste Nousbaum
- Registre des cancers digestifs du Finistère, University Hospital of Brest, Brest, France; EA7479 SPURBO, University of Western Brittany, Brest, France
| | - Arnaud Alves
- UMR INSERM 1086 'ANTICIPE', Centre François Baclesse, Caen, France; Registre des cancers digestifs du Calvados, University Hospital of Caen, Caen, France; Department of Digestive Surgery, University Hospital of Caen, Caen, France
| | - Olivier Dejardin
- UMR INSERM 1086 'ANTICIPE', Centre François Baclesse, Caen, France; Department of Research, Epidemiology Research and Evaluation Unit, University Hospital of Caen, Caen, France
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Ganga A, Kim EJ, Mintzer GL, Adriance W, Wang R, Cholankeril G, Balkrishnan R, Somasundar PS. Disparities in primary pancreatic adenocarcinoma survival by Medicaid-status: A national population-based risk analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1242-1249. [PMID: 36801151 DOI: 10.1016/j.ejso.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/20/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Pancreatic adenocarcinoma (PAC) has one of the highest mortality rates among all malignancies. While previous research has analyzed socioeconomic factors' effect on PAC survival, outcomes of Medicaid patients are understudied. METHODS Using the SEER-Medicaid database, we studied non-elderly, adult patients with primary PAC diagnosed between 2006 and 2013. Five-year disease-specific survival analysis was performed using the Kaplan-Meier method and adjusted analysis using Cox proportional-hazards regression. RESULTS Among 15,549 patients (1799 Medicaid, 13,750 non-Medicaid), Medicaid patients were less likely to receive surgery (p < .001) and more likely to be non-White (p < .001). The 5-year survival of non-Medicaid patients (8.13%, 274 days [270-280]) was significantly higher than that of Medicaid patients (4.97%, 152 days, [151-182], p < .001). Among Medicaid patients, those in high poverty areas had significantly lower survival rates (152 days [122-154]) than those in medium poverty areas (182 days [157-213], p = .008). However, non-White (152 days [150-182]) and White Medicaid patients (152 days [150-182]) had similar survival (p = .812). On adjusted analysis, Medicaid patients were still associated with a significantly higher risk of mortality (aHR 1.33 [1.26-1.41], p < .0001) compared to non-Medicaid patients. Unmarried status and rurality were associated with a higher risk of mortality (p < .001). DISCUSSION Medicaid enrollment prior to PAC diagnosis was generally associated with a higher risk of disease-specific mortality. While there was no difference in the survival between White and non-White Medicaid patients, Medicaid patients living in high poverty areas were shown to be associated with poor survival.
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Affiliation(s)
- Arjun Ganga
- Roger Williams Medical Center, Division of Surgical Oncology, Providence, RI, USA
| | - Eric J Kim
- Roger Williams Medical Center, Division of Surgical Oncology, Providence, RI, USA
| | - Gabriel L Mintzer
- Massachusetts Institute of Technology, Department of Computer Science, Cambridge, MA, USA
| | - William Adriance
- Brown University, Department of Computer Science, Providence, RI, USA
| | - Rachel Wang
- Brown University, Department of Computer Science, Providence, RI, USA
| | | | | | - Ponnandai S Somasundar
- Roger Williams Medical Center, Division of Surgical Oncology, Providence, RI, USA; Boston University Chobanian & Avedisian School of Medicine, Department of Surgery, Boston, MA, USA.
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Romutis S, Brand R. Burden of New Pancreatic Cyst Diagnosis. Gastrointest Endosc Clin N Am 2023; 33:487-495. [PMID: 37245931 DOI: 10.1016/j.giec.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Pancreatic cysts are an increasingly identified entity with significant health care implications. Although some cysts present with concurrent symptoms that often require operative intervention, the advent of improved cross-sectional imaging has heralded an era of increased incidentally detected pancreatic cysts. Although the rate of malignant progression in pancreatic cysts remains low, the poor prognosis of pancreatic malignancy has driven recommendations for ongoing surveillance. A uniform consensus has not been reached on the management and surveillance of pancreatic cysts leading clinicians to grapple with the burden of how best to approach pancreatic cysts from a health, psychosocial, and cost perspective.
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Affiliation(s)
- Stephanie Romutis
- UPMC Division of Gastroenterology, Hepatology, and Nutrition, 200 Lothrop Street, Mezzanine Level C-wing, Pittsburgh, PA 15213, USA.
| | - Randall Brand
- UPMC Division of Gastroenterology, Hepatology, and Nutrition, 200 Lothrop Street, Mezzanine Level C-wing, Pittsburgh, PA 15213, USA
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Petric J, Handshin S, Jonnada PK, Karunakaran M, Barreto SG. The influence of socioeconomic status on access to cancer care and survival in resectable pancreatic cancer: a systematic review and meta-analysis. ANZ J Surg 2022; 92:2795-2807. [PMID: 35938456 DOI: 10.1111/ans.17964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/21/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Socioeconomic status (SES) is an important factor affecting access to cancer care and survival. Its role in pancreatic cancer warrants scrutiny. METHODS A systematic review of major reference databases was undertaken. Categorization of the study population into low SES (LSES) and high SES (HSES) was based on the criteria employed in the individual studies. The outcome measures studied were stage of cancer presentation, access to care and overall survival. Meta-analysis was performed using random-effects models and trial sequential analysis (TSA) was used to assess the precision and conclusiveness of the results. RESULTS Thirteen studies meeting inclusion criteria were included in the meta-analysis, which demonstrated that LSES was associated with significantly lower rates of presentation at a non-metastatic stage and poorer access to cancer care, viz. surgery, chemotherapy and radiation therapy. Despite heterogeneity, TSA supported the findings, displaying minimal type I error. CONCLUSION As LSES is associated with delayed presentation, poorer access to care and poorer survival, SES should be considered a modifiable risk factor for poor outcomes in pancreatic cancer.
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Affiliation(s)
- Josipa Petric
- Department of Surgery, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | - Samuel Handshin
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Pavan Kumar Jonnada
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, India
| | - Monish Karunakaran
- College of Medicine and Public Health, Flinders University, South Australia, Australia.,Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Savio George Barreto
- College of Medicine and Public Health, Flinders University, South Australia, Australia.,Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
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Fabregas JC, Riley KE, Brant JM, George TJ, Orav EJ, Lam MB. Association of social determinants of health with late diagnosis and survival of patients with pancreatic cancer. J Gastrointest Oncol 2022; 13:1204-1214. [PMID: 35837201 DOI: 10.21037/jgo-21-788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/30/2022] [Indexed: 12/22/2022] Open
Abstract
Background Pancreatic cancer disparities have been described. However, it is unknown if they contribute to a late diagnosis and survival of patients with metastatic disease. Identifying their role is important as it will open the door for interventions. We hypothesize that social determinants of health (SDH) such as income, education, race, and insurance status impact (I) stage of diagnosis of PC (Stage IV vs. other stages), and (II) overall survival (OS) in Stage IV patients. Methods Using the National Cancer Database, we evaluated a primary outcome of diagnosis of Stage IV PC and a secondary outcome of OS. Primary predictors included race, income, education, and insurance. Covariates included age, sex and Charlson-Deyo comorbidity score. Univariate, multivariable logistic regression models evaluated risk of a late diagnosis. Univariate, multivariable Cox proportional hazards model examined OS. 95% confidence intervals were used. Results 230,877 patients were included, median age of 68 years (SD 12.1). In univariate analysis, a better education, higher income, and insurance decreased the odds of Stage IV PC, while Black race increased it. In multivariable analysis, education [>93% high-school completion (HSC) vs. <82.4%, OR 0.96 (0.93-0.99)] and insurance [private vs. no, OR 0.72 (0.67-0.74)] significantly decreased the risk of a late diagnosis, whereas Black race increased the odds [vs. White, OR 1.09 (1.07-1.12)]. In univariate Cox analysis, having a higher income, insurance and better education improved OS, while Black race worsened it. In multivariable Cox, higher income [>$63,333 (vs. <$40,277), HR 0.87 (0.85-0.89)] and insurance [private vs. no, HR 0.77 (0.74-0.79)] improved OS. Conclusions SDH impacted the continuum of care for patients with advanced pancreatic cancer, including stage at diagnosis and overall survival.
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Affiliation(s)
- Jesus C Fabregas
- Division of Hematology Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA.,University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Kristen E Riley
- Harvard Medical School, Department of Medicine, Boston, MA, USA
| | | | - Thomas J George
- Division of Hematology Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA.,University of Florida Health Cancer Center, Gainesville, FL, USA
| | - E John Orav
- Harvard Medical School, Department of Medicine, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, USA
| | - Miranda B Lam
- Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA.,Harvard T. H. Chan School of Public Health, Department of Health Policy and Management, Boston, MA, USA
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8
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Nilbert M. Changing before we have to; how to mitigate disparities in pancreatic cancer care? Acta Oncol 2022; 61:275-276. [PMID: 35172684 DOI: 10.1080/0284186x.2022.2041720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Mef Nilbert
- Department of Hematology, Oncology, and Radiophysics, Skåne University Hospital, Lund, Sweden
- Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark
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Eskander MF, Hamad A, Li Y, Fisher JL, Oppong B, Obeng-Gyasi S, Tsung A. From street address to survival: Neighborhood socioeconomic status and pancreatic cancer outcomes. Surgery 2021; 171:770-776. [PMID: 34876291 DOI: 10.1016/j.surg.2021.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/10/2021] [Accepted: 10/07/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Neighborhood factors may influence cancer care through physical, economic, and social means. This study assesses the impact of neighborhood socioeconomic status on diagnosis, treatment, and survival in pancreatic cancer. METHODS Patients with pancreatic adenocarcinoma were identified in the 2010-2016 Surveillance Epidemiology and End Results database. Neighborhood socioeconomic status (divided into tertiles) was based on an National Cancer Institute census tract-level composite score, including income, education, housing, and employment. Multivariate models predicted metastasis at time of diagnosis and receipt of surgery for early-stage disease. Overall survival compared via Kaplan-Meier and Cox proportional hazards. RESULTS Fifteen thousand four hundred and thirty-six patients (29.7%) lived in low neighborhood socioeconomic status, 17,509 (33.7%) in middle neighborhood socioeconomic status, and 19,010 (36.6%) in high neighborhood socioeconomic status areas. On multivariate analysis, neighborhood socioeconomic status was not associated with metastatic disease at diagnosis (low neighborhood socioeconomic status odds ratio 1.02, 95% confidence interval 0.97-1.07; ref: high neighborhood socioeconomic status). However, low neighborhood socioeconomic status was associated with decreased likelihood of surgery for localized/regional disease (odds ratio 0.60, 95% confidence interval 0.54-0.68; ref: high neighborhood socioeconomic status) and worse overall survival (low neighborhood socioeconomic status hazard ratio 1.18, 95% confidence interval 1.15-1.21; ref: high neighborhood socioeconomic status). CONCLUSION Patients from resource-poor neighborhoods are less likely to receive stage-appropriate therapy for pancreatic cancer and have an 18% higher risk of death.
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Affiliation(s)
- Mariam F Eskander
- The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, Columbus, OH; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Ahmad Hamad
- The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, Columbus, OH
| | - Yaming Li
- The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, Columbus, OH
| | - James L Fisher
- The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, Columbus, OH
| | - Bridget Oppong
- The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, Columbus, OH
| | - Samilia Obeng-Gyasi
- The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, Columbus, OH
| | - Allan Tsung
- The Arthur G. James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, Columbus, OH.
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