Racial and age disparities in pancreatic cancer treatment and survival

Mini Oral Session Abstracts Methods: Data regarding demographics, NeoTx, surgical outcomes, pathology and survival data were abstracted on consecutive pts with BRPCa, diagnosed between 2008 and 2016 and not enrolled in clinical trials. BRPCa was defined based on local tumor anatomy, pre-treatment CA19-9 >2000, presence of indeterminate radiographic lesions suspicious for metastases, or rarely, performance status concerns thought to be recoverable. Results: NeoTx was given to 154 pts with BRPCa; 19 (12%) pts received chemoradiation, 13 (8%) chemotherapy, and 122 (79%) had both. Of the 154 pts, 92(60%) completed all NeoTx and surgery. Of the 92 resected patients, 65 [71%] underwent pancreaticoduodenectomy and vascular reconstruction was performed in 51 (60%) pts. Final pathology in the 92 pts demonstrated that 68 (74%) were node negative and 5 (5%) were margin positive. Median overall survival for all patients was 19 months; 30.8 months for the 92 pts who completed all therapy including surgery and 11.9 months for the 62 pts who underwent NeoTx but were not resected (p < 0.001). For the 92 pts, the two and three year survivals were 61% and 46% respectively. Conclusion: Following NeoTx, surgical resection was performed in 60% of patients with BRPCa. Adaptive approaches to neoadjuvant therapy guided by objective biochemical and radiographic responses to therapy are needed to optimize NeoTx for BRPCa patients and better determine who should and should not undergo operation.

MO 127 RACIAL AND AGE DISPARITIES IN PANCREATIC CANCER TREATMENT AND SURVIVAL A. Scholer, O. Mahmoud, D. Gosh, R. Wieder, N. Adam and R. Chokshi Rutgers University, Nutley, NJ, USA

HPB 2017, 19 (S1), S40eS108

S97

Objective: We postulate a disparity in pancreatic cancer treatment (surgery alone, surgery + chemotherapy  radiation, and no surgery (chemotherapy  radiation)) leads to adverse outcomes in certain groups. Methods: We performed a retrospective review of Medicare-Surveillance, Epidemiology and End Results from 1973e2013. The association of socioeconomic and treatment disparities on 3-year overall survival was analyzed. Results: We identified 11,412 patients with pancreatic adenocarcinoma (stage II/III, 5,504 (48.2%), stage IV, 4,816 (42.2%) and stage I, 1,092 (9.6%)). Three-year overall survival for stage II/III pancreatic cancer demonstrated surgery + chemotherapy  radiation group has the greatest overall survival (Figure 1). Multivariate analysis of stage II and III pancreatic cancer demonstrated the surgery + chemotherapy  radiation group had improved overall survival compared to the surgery alone ([OR] = 0.74 (0.69e0.788)). In addition, patients who did not undergo surgery had worse overall survival than patients who underwent resection ([OR] = 1.23 (1.15e 1.132)). African Americans and patients older than 74 years receive significantly less surgery + chemotherapy  radiation than Caucasians and patients younger than 74 years, ([0R] = 0.50; 95% CI, 0.37e0.68) and ([OR] = 0.56; 95% CI, (0.47e0.67), respectively. This disparity is reflected in their significantly worse survival ([OR] = 1.11; 95% CI (1.01e1.23) and ([OR] = 1.35 (1.27e1.43), respectively. Conclusion: In this elderly cohort, this study identified disparities independently associated with pancreatic cancer survival; race, age, and treatment. Three-year overall survival for stage II/III pancreatic cancer is increased with surgery + chemotherapy  radiation. To improve outcomes, increase accessibility, and limiting treatment choice to disease related factors should be sought even for elderly patients.

Figure 1 Association of different treatment modalities with

overall survival for patients with stages II and III pancreatic adenocarcinoma.