Presence of Lymph Node Metastasis Has a Greater Impact on Survival in Black Patients with Pancreatic Cancer: An Effect of Tumor Biology or a Disparity in Treatment?

Introduction: Despite aggressive surgical care and systemic therapy, patients with pancreatic ductal adenocarcinoma (PDAC) have a poor prognosis. Recent studies show that racial disparity in outcome also exists. We determined the difference in survival between Black and White PDAC patients after resection. Methods: Retrospective analysis of 226 PDAC patients who underwent resection at a single institution from 2010-2018 was performed with attention to lymph node (LN) metastasis and patient race. The number of patients who received chemotherapy was also evaluated. Results: 175 (77.4%) PDAC patients were White and 51 (22.6%) were Black. 130 (59.3%) patients had LN metastasis (LN+). LN+ and LN- groups were similar in race (p=0.93), sex (p=0.10), and age at the time of diagnosis (p=0.45). Patients with LN+ disease were more likely to present with larger tumors (3.4 vs. 2.8cm, p=0.02) and higher T status (p=0.001). White and Black patients had similar rates of LN metastasis (59% vs.58.8%, p=1.0). Median survival for LN- Black and White patients were similar (43.2 vs. 30.2 months, p=0.82). LN+ Black patients trended towards receiving more systemic therapy than White LN+ patients (55% vs. 42%, p=0.10). Median survival for LN+ Black patients was significantly less than LN+ White patients (17.5 vs. 24.6 months, p=0.04, FIGURE). Conclusion: Black LN+ PDAC patients have an inferior survival rate after resection when compared to their White counterparts. Our disparity in outcome cannot be solely explained by a difference in systemic treatment. Further investigation is warranted to determine racial differences in tumor biology or response to chemotherapy.