Masoud Sabran J, Bartholomew Alex J, Lidsky Michael E, Nussbaum Daniel P, Blazer Dan G, Mureebe Leila, Mantyh Christopher R, Allen Peter J, Martin Allison N
Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Department of Surgery, Veterans Affairs Medical Center, Durham, NC, USA.
Ann Surg Oncol. 2025 Sep 2. doi: 10.1245/s10434-025-18232-6.
Veterans Affairs (VA) patients participate within the largest USA equal-access healthcare system, though still experience cancer mortality disparities by social determinants. The Social Vulnerability Index (SVI)-measuring community poverty, minority status, housing, and transportation-has delineated gradients in cancer care utilization and outcomes. We therefore assessed relationships between SVI and mortality in veterans with pancreatic ductal adenocarcinoma (PDAC).
Records of patients with stage I-III PDAC diagnosed January 2005-December 2018 were abstracted from the VA Corporate Data Warehouse. Addresses were geocoded to SVI. Mann-Whitney U and chi-squared tests compared baseline characteristics. Overall survival (OS) was compared using Kaplan-Meier and multivariable Cox proportional hazards methods.
A total of 1778 patients were evaluated, of which 570 (32%) underwent surgical resection. A total of 516 (29%) patients originated from census tracts in the highest SVI quartile. These patients were more likely Black (38% vs 13%), unemployed (49% vs 35%), and metropolitan-based (87% vs 76%; all p < 0.001). Over a median follow-up of 8.7 months, median OS was 9.5 months versus 10.2 months for high and low SVI groups, respectively (log-rank p = 0.03). In the resected cohort, high and low SVI groups reflected a median OS of 18.2 months versus 23.1 months, respectively (log-rank p < 0.01). High SVI remained independently associated with mortality for resected patients only (hazard ratio [HR] 1.4, p < 0.01).
High SVI was associated with poorer prognosis after PDAC resection. Acknowledging a need to identify mechanisms, SVI has potential use in triaging PDAC survivorship interventions in veterans.
退伍军人事务部（VA）的患者参与美国最大的平等医疗保健系统，但仍因社会因素存在癌症死亡率差异。社会脆弱性指数（SVI）用于衡量社区贫困、少数族裔地位、住房和交通状况，已勾勒出癌症治疗利用率和治疗结果的梯度差异。因此，我们评估了SVI与胰腺导管腺癌（PDAC）退伍军人死亡率之间的关系。
从VA企业数据仓库中提取2005年1月至2018年12月诊断为I - III期PDAC患者的记录。将地址进行地理编码以获取SVI。采用曼 - 惠特尼U检验和卡方检验比较基线特征。使用Kaplan - Meier法和多变量Cox比例风险模型比较总生存期（OS）。
共评估了1778例患者，其中570例（32%）接受了手术切除。共有516例（29%）患者来自SVI最高四分位数的普查区。这些患者更可能是黑人（38%对13%）、失业（49%对35%）且居住在大都市地区（87%对76%；所有p < 0.001）。中位随访8.7个月，高SVI组和低SVI组的中位OS分别为9.5个月和10.2个月（对数秩检验p = ）。在接受手术切除队列中，高SVI组和低SVI组的中位OS分别为18.2个月和23.1个月（对数秩检验p < 0.01）。仅在接受手术切除的患者中，高SVI仍与死亡率独立相关（风险比[HR] 1.4，p < 0.01）。
高SVI与PDAC切除术后预后较差相关。认识到需要确定相关机制，SVI在对退伍军人PDAC生存干预进行分类方面具有潜在用途。 （注：原文中“log-rank p = 0.03”和“log-rank p < 0.01”处的“ = ”和“ < ”后面缺少具体数值，翻译时保留原文格式）
