Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA.
Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA.
J Surg Oncol. 2022 Aug;126(2):302-313. doi: 10.1002/jso.26859. Epub 2022 Mar 22.
BACKGROUND AND METHODS: Racial and socioeconomic disparities in receipt of adjuvant chemotherapy affect patients with pancreatic cancer. However, differences in receipt of neoadjuvant chemotherapy among patients undergoing resection are not well-understood. A retrospective cross-sectional cohort of patients with resected AJCC Stage I/II pancreatic ductal adenocarcinoma was identified from the National Cancer Database (2014-2017). Outcomes included receipt of neoadjuvant versus adjuvant chemotherapy, or receipt of either, defined as multimodality therapy and were assessed by univariate and multivariate analysis.
Of 19 588 patients, 5098 (26%) received neoadjuvant chemotherapy, 9624 (49.1%) received adjuvant chemotherapy only, and 4757 (24.3%) received no chemotherapy. On multivariable analysis, Black patients had lower odds of neoadjuvant chemotherapy compared to White patients (OR: 0.80, 95% CI: 0.67-0.97) but no differences in receipt of multimodality therapy (OR: 0.89, 95% CI: 0.77-1.03). Patients with Medicaid or no insurance, low educational attainment, or low median income had significantly lower odds of receiving neoadjuvant chemotherapy or multimodality therapy.
Racial and socioeconomic disparities persist in receipt of neoadjuvant and multimodality therapy in patients with resected pancreatic adenocarcinoma.
Policy and interventional implementations are needed to bridge the continued socioeconomic and racial disparity gap in pancreatic cancer care.
背景与方法：接受辅助化疗的种族和社会经济差异会影响胰腺癌患者。然而，接受新辅助化疗的患者之间的差异尚未得到充分理解。本研究从国家癌症数据库（2014-2017 年）中确定了接受 AJCC 分期 I/II 胰腺导管腺癌切除术的患者的回顾性横断面队列。结果包括接受新辅助化疗与辅助化疗，或接受任何一种化疗（定义为多模式治疗），并通过单变量和多变量分析进行评估。
在 19588 名患者中，5098 名（26%）接受了新辅助化疗，9624 名（49.1%）仅接受了辅助化疗，4757 名（24.3%）未接受化疗。多变量分析显示，与白人患者相比，黑人患者接受新辅助化疗的可能性较低（OR：0.80，95%CI：0.67-0.97），但接受多模式治疗的可能性无差异（OR：0.89，95%CI：0.77-1.03）。拥有医疗补助或没有保险、教育程度低或中位收入低的患者接受新辅助化疗或多模式治疗的可能性显著降低。
在接受胰腺腺癌切除术的患者中，新辅助化疗和多模式治疗的接受情况仍存在种族和社会经济差异。
需要实施政策和干预措施，以缩小胰腺癌治疗中持续存在的社会经济和种族差异差距。
