Racial Disparities in Chemotherapy Response in Pancreatic Cancer: A Landmark Survival Analysis

Racial disparities in pancreatic adenocarcinoma mortality may stem from differences in chemotherapy response. This study examines potential disparities between Black and White patients' responses to adjuvant chemotherapy.

Using the National Cancer Database (2010-2019), we analyzed Black and White patients with pancreatic adenocarcinoma who underwent surgery with or without adjuvant therapy. Patients receiving neoadjuvant therapy, radiation, with American Joint Committee on Cancer stage >4, or missing data were excluded. A race-stratified landmark survival analysis was performed at 6 mo post surgery using Kaplan-Meier and Cox proportional hazards models.

Among 22,898 surgical patients, 20,434 were White (89%) and 2464 were Black (11%) and the median follow-up was 19.9 mo. Black patients were younger (65.6 versus 69.0 y), more often female (58% versus 48%), and had higher Charlson-Deyo Comorbidity Index (CCI) scores (≥3: 6.0% versus 4.6%) than White patients. Black patients were less likely to receive adjuvant therapy (58% versus 61%). At 6 mo post surgery, 18,977 patients were alive, with 65% receiving chemotherapy. Cox analysis revealed a significant survival benefit from adjuvant therapy in White patients (hazard ratio = 0.90, 95% confidence interval = 0.87-0.95, P < 0.01); a similar effect was not seen in Black patients (hazard ratio = 0.96, 95% confidence interval = 0.84-1.09, P = 0.52).

Although overall survival is similar, adjuvant chemotherapy was associated with improved survival only in White patients. The lack of observed benefit in Black patients may indicate underlying biological differences warranting further study.