Division of Surgical Oncology, Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
Ann Surg Oncol. 2021 Feb;28(2):1088-1096. doi: 10.1245/s10434-020-08717-x. Epub 2020 Jul 10.
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.
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.
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.
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.
先前的研究发现，在可切除胰腺腺癌的胰腺切除术方面存在种族差异。本研究旨在调查在边界可切除胰腺腺癌行胰十二指肠切除术时，种族差异是否更严重。
本研究使用了国家癌症数据库（2004-2016 年），并纳入了非转移性和胰腺头部边界可切除胰腺腺癌患者。采用多变量泊松回归模型和稳健标准差评估非白人患者（黑人、亚洲人和非白人西班牙裔）与白人患者相比行胰十二指肠切除术的相对风险（RR）。采用带有医院固定效应的泊松回归模型来评估发现是否归因于医院内或医院间的差异。还评估了种族与新辅助治疗之间的相互作用。
共有 15482 名（中位年龄 68 岁，四分位距 60-76 岁；48.6%为男性）边界可切除胰腺腺癌患者，主要为白人（84.3%，n=13058；非白人，15.7%，n=2424）。总体而言，2853 例（18.4%）进行了胰腺切除术。与白人患者相比，非白人患者行边界可切除胰腺腺癌胰腺切除术的可能性显著降低（RR 0.75，95%置信区间 0.68-0.83；p<0.001）。这些发现在医院固定效应模型中仍然存在。在交互分析中，如果患者接受新辅助治疗，胰腺切除术的可能性没有显著差异。
与白人患者相比，非白人患者行边界可切除胰腺腺癌胰腺切除术的可能性低 25%。这种种族差异是由于医院内治疗的差异造成的，如果非白人患者接受新辅助治疗，这种差异就会消失。
