Racial Disparity in Pathologic Response following Neoadjuvant Chemotherapy in Resected Pancreatic Cancer: A Multi-Institutional Analysis from the Central Pancreatic Consortium

Ifeanyichukwu Ogobuiro, Amber L. Collier, Khadeja Khan, Iago de Castro Silva, Deukwoo Kwon, Gregory C. Wilson, Patrick B. Schwartz, Alexander A. Parikh, Chet Hammill, Hong J. Kim, David A. Kooby, Daniel Abbott, Shishir K. Maithel, Rebecca A. Snyder, Syed A. Ahmad, Nipun B. Merchant, Jashodeep Datta

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Major pathologic response (MPR) following neoadjuvant therapy (NAT) in pancreatic ductal adenocarcinoma (PDAC) patients undergoing resection is associated with improved survival. We sought to determine whether racial disparities exist in MPR rates following NAT in patients with PDAC undergoing resection. Methods: Patients with potentially operable PDAC receiving at least 2 cycles of neoadjuvant FOLFIRINOX or gemcitabine/nab-paclitaxel ± radiation followed by pancreatectomy (2010-2019) at 7 high-volume centers were reviewed. Self-reported race was dichotomized as Black and non-Black, and multivariable models evaluated the association between race and MPR (i.e., pathologic complete response [pCR] or near-pCR). Cox regression evaluated the association between race and disease-free (DFS) and overall survival (OS). Results: Results of 486 patients who underwent resection following NAT (mFOLFIRINOX 56%, gemcitabine/nab-paclitaxel 25%, radiation 29%), 67 (13.8%) patients were Black. Black patients had lower CA19-9 at diagnosis (median 67 vs. 204 U/mL; P = 0.003) and were more likely to undergo mild/moderate chemotherapy dose modification (40 vs. 20%; P = 0.005) versus non-Black patients. Black patients had significantly lower rates of MPR compared with non-Black patients (13.4 vs. 25.8%; P = 0.039). Black race was independently associated with worse MPR (OR 0.26, 95% confidence interval [CI] 0.10-0.69) while controlling for NAT duration, CA19-9 dynamics, and chemotherapy modifications. There was no significant difference in DFS or OS between Black and non-Black cohorts. Conclusions: Black patients undergoing pancreatectomy appear less likely to experience MPR following NAT. The contribution of biologic and nonbiologic factors to reduced chemosensitivity in Black patients warrants further investigation.

Original languageEnglish (US)
Pages (from-to)1485-1494
Number of pages10
JournalAnnals of Surgical Oncology
Volume30
Issue number3
DOIs
StatePublished - Mar 2023
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Surgery

Fingerprint

Dive into the research topics of 'Racial Disparity in Pathologic Response following Neoadjuvant Chemotherapy in Resected Pancreatic Cancer: A Multi-Institutional Analysis from the Central Pancreatic Consortium'. Together they form a unique fingerprint.

Cite this