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IMPACT OF BMI AND SOCIAL VULNERABILITY ON POSTOPERATIVE OUTCOMES IN PANCREATIC ADENOCARCINOMA
Basheer Elsolh
*, Jennifer Hwang, Emily Papai, Jordan D. Fredette, Leonard Miller, Hal Rives, Joseph Krempa, Anthony Villano, Sanjay S. Reddy
Fox Chase Cancer Center, Philadelphia, PA
Introduction: The prognosis of pancreatic ductal adenocarcinoma (PDAC) has improved over time, with advancements in surgical and non-surgical therapies. Despite this, disparities in outcomes exist and can be traced to patients’ socioeconomic factors. The Center for Disease Control (CDC) uses the Social Vulnerability Index (SVI) to identify communities experiencing social vulnerability and are therefore at higher risk for health inequalities, including body mass index (BMI). We assess the interaction between BMI and social vulnerability on outcomes in patients with PDAC.
Methods: A retrospective review of a prospectively-maintained database of 1,078 medical records of patients with PDAC receiving care at our institution. 193 subjects had surgery after 2012 and were included. Subjects were dichotomized based on high (>=0.75) and low/medium risk (<0.75) as defined by the CDC. Primary outcomes were surgical margin status, postoperative pancreatic fistula (POPF) rate, overall survival, progression-free survival. Secondary outcomes included duration of neoadjuvant chemotherapy. Outcomes were assessed based on SVI status, and correlation with BMI was evaluated for. Survival analysis was performed with a Cox proportional hazards model.
Results: Of the 193 subjects, 24 (12.4%) qualified as high-risk SVI, and 169 (87.6%) were low-risk. In high-risk subjects, 23 (95.8%) had negative margins and 1 (4.2%) had positive margins, while 155 (91.7%) low-risk subjects had negative margins and 15 (7.8%) had positive margins (p=0.699). There was no significant difference in duration of neoadjuvant chemotherapy between high and low risk groups (p = 0.796), but an interaction between BMI and SVI was identified, and this had a significant impact on the length of neoadjuvant chemotherapy received (p = 0.048). POPF was identified in 1 (4.7%) high-risk patient and 14 (8.3%) low-risk patients (p=1.0). Among high-risk patients, median PFS and OS were 42.8 and 71.8 months, respectively, versus 25.3 and 42.9 months among low-risk patients (p=0.11, p=0.45).When adjusting for possible confounders (sex, age, BMI, ECOG performance status, and year of surgery), each 0.1 increase in HTT score is associated with an 11.5% increase in mortality risk (p=0.018). Statistical significance was absent from all other SVI variables in Cox regression analyses.
Conclusion: In this single-center cohort, SVI score and BMI appear to have an interaction in relation to duration of neoadjuvant chemotherapy received, but the aggregate of the two metrics does not appear to affect more relevant oncologic outcomes such as margin status, progression-free or overall survival, or postoperative pancreatic fistula rate.
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