Madnick David, Handorf Elizabeth, Ortiz Angel, Sorice Kristen, Nagappan Lavanya, Moccia Matthew, Cheema Khadija, Vijayvergia Namrata, Dotan Efrat, Lynch Shannon M
Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
Population Studies Facility, Fox Chase Cancer Center, Philadelphia, PA, USA.
J Gastrointest Oncol. 2020 Aug;11(4):633-643. doi: 10.21037/jgo-20-39.
Pancreatic adenocarcinoma (PCA) incidence is higher in Black compared to White patients. Beyond race, neighborhood socioeconomic status (nSES) may also inform disparities. However, these effects on metastatic pancreatic adenocarcinoma (mPCA) are not well-studied. The aim of this study was to explore whether nSES influences survival in patients with mPCA.
nSES measures were derived from U.S. census data at the census tract (CT) level. We correlated medical records of mPCA patients (diagnosed 2010-2016; n=370) to nSES measures retrospectively via a geocode derived from patient address. Multivariable cox proportional hazards models were used to identify patient-level (age, sex, race, marital status, treatment (radiation/chemo/surgery), PCA family history, stage, Jewish ancestry, tobacco use, BMI, diabetes, and statin use) and nSES measures (deprivation, racial concentration, stability, transportation access, immigration) associated with mPCA survival; P values <0.05 were significant.
Eighty-two percent of patients were White; less than one-third of patients resided in highly deprived neighborhoods. Three hundred thirty-three mPCA patient deaths occurred, with a survival ranging from 7-9 months (median 8 months). Patient-level factors including younger age, receipt of chemotherapy or initial surgery and statin use, were associated with improved survival, whereas neighborhood stability (i.e., a higher % of residents still living in the same house as 1 year ago) was significantly associated with poor pancreatic survival.
Our findings suggest nSES has limited effect on survival of mPCA patients as compared to clinical variables. This may be due to the aggressive nature of this cancer, however, additional studies with larger, more diverse cohorts are needed to better understand the effect of nSES on survival of patients with mPCA.
与白人患者相比，黑人胰腺癌（PCA）的发病率更高。除种族外，社区社会经济地位（nSES）也可能导致差异。然而，这些因素对转移性胰腺癌（mPCA）的影响尚未得到充分研究。本研究的目的是探讨nSES是否会影响mPCA患者的生存率。
nSES指标来自人口普查区（CT）层面的美国人口普查数据。我们通过患者地址得出的地理编码，将mPCA患者（2010 - 2016年诊断；n = 370）的病历与nSES指标进行回顾性关联。多变量Cox比例风险模型用于确定与mPCA生存相关的患者层面因素（年龄、性别、种族、婚姻状况、治疗（放疗/化疗/手术）、PCA家族史、分期、犹太血统、吸烟、BMI、糖尿病和他汀类药物使用）和nSES指标（贫困程度、种族集中程度、稳定性、交通便利性、移民情况）；P值<0.05具有统计学意义。
82%的患者为白人；不到三分之一的患者居住在高度贫困社区。发生了333例mPCA患者死亡，生存期为7 - 9个月（中位数8个月）。包括年龄较小、接受化疗或初次手术以及使用他汀类药物在内的患者层面因素与生存率提高相关，而社区稳定性（即与1年前仍居住在同一房屋的居民百分比更高）与胰腺癌患者生存率低显著相关。
我们的研究结果表明，与临床变量相比，nSES对mPCA患者生存率的影响有限。这可能是由于这种癌症的侵袭性所致，然而 需要更多更大、更多样化队列的研究，以更好地了解nSES对mPCA患者生存的影响。
