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ASSOCIATION OF NEIGHBORHOOD LEVEL FACTORS AND RESPONSE TO NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH PANCREATIC DUCTAL ADENOCARCINOMA
Muhammad Maisam Ali
*, Manasa Ventkatesh, Clayton T. Marcinak, Syed Nabeel Zafar
University of Wisconsin School of Medicine and Public Health, Madison, WI
IntroductionNeoadjuvant chemotherapy, followed by surgical resection, is currently a mainstay of treatment for pancreatic ductal adenocarcinoma (PDAC). Evidence suggests racial and socioeconomic disparities exist in the delivery of care for PDAC. Previous literature has identified that response to chemotherapy may vary with social determinants of health (SDoH) in other cancers, such as breast. However, less is known about how socioeconomic determinants, in particular neighborhood-level factors, influence tumor response to curative-intent treatment for PDAC. This study aims to assess the relationship between pathological response to neoadjuvant chemotherapy and social determinants of health.
MethodsPatients aged 18 years and above who presented to a single high-volume academic center between 1 January 2017and 15 November 2024 were identified. Patients were included if they had a histologically confirmed diagnosis of PDAC and had received neoadjuvant chemotherapy without neoadjuvant radiotherapy followed by curative-intent surgery. Pathological response (PR) was assessed from surgical pathology reports using the College of American Pathologists’ tumor regression grading system for pancreatic cancer. A score of 0 (complete response) or 1 (near-complete response) was categorized as a major response; a score of 2 (partial response) or 3 (absent response) was categorized as a minor response. Pathological response was then compared to residence-based measures of SDoH, including the Area Deprivation Index (ADI), rural-urban classification by using RUCA Codes, and distance to treating facility in miles categorized in tertiles. Differences in state rankings for ADI between groups with major PR versus minor PR were assessed using the Mann-Whitney U test, whereas rural-urban classification and distance to treating facility were compared using the chi-squared test.
ResultsOf the total 154 patients included in the final analysis, the mean age was 65.2 (SD: 8.7), with 45.4% female patients. 88% patients had a minor PR. The median state-ranked ADI was 5.0 (IQR: 4.0) and 21.4% patients resided in rural areas, and 78.6% resided in urban or suburban areas. Patients who had a minor PR were more likely to reside in high neighborhood disadvantaged areas compared to those that lived in low disadvantaged neighborhoods (p=0.041) (Table 1). Patients in rural areas were more likely to have a minor pathological response (97.0%) compared to patients in urban or suburban areas (86.2%) (p = 0.049). There was no significant association between PR and distance to facility in tertiles.
ConclusionOur analysis indicates that response to neoadjuvant chemotherapy is associated with neighborhood-level factors, including deprivation and rural residence. Further studies are needed to determine why these disparities exist and how they influence tumor biology and treatment outcomes.
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