Abstract A112: The impact of race, stage at diagnosis, and socioeconomic status on survival in pancreatic cancer
TL;DR
Stage at diagnosis was the strongest predictor of survival, with localized and regional disease associated with substantially lower mortality than distantStage at diagnosis was the strongest predictor of survival, with localized and regional disease associated with substantially lower mortality than distant stage disease.
Abstract
Pancreatic cancer remains one of the most lethal malignancies, largely because most patients present with advanced disease. Although racial disparities in pancreatic cancer outcomes are well documented, the extent to which these differences are attributable to stage at diagnosis and socioeconomic status (SES) is not fully understood. This study examined racial differences in stage at diagnosis and overall survival in a large population-based cohort. We performed a retrospective study of 158,308 patients diagnosed with pancreatic cancer in the Surveillance, Epidemiology, and End Results (SEER) 17 registries from 1998 to 2017. Race was categorized as White, Black, Asian or Pacific Islander (API), and American Indian/Alaska Native (AI/AN). Stage was classified as localized, regional, or distant. SES was estimated using county level median household income quintiles. Differences in stage at diagnosis were evaluated using chi-square analysis. Overall survival was estimated using Kaplan-Meier methods and compared with the log-rank test. Multivariable Cox proportional hazards regression was performed to evaluate the independent associations of race, stage, and SES with mortality. Stage at diagnosis differed significantly by race (χ2 = 117.56, df = 8, p < 0.001). Distant-stage disease was the most common presentation across all racial groups, occurring in 59.6% of Black patients, 58.5% of AI/AN patients, 56.4% of White patients, and 54.8% of API patients. API patients had the highest proportion of regional-stage disease (33.2%), whereas localized disease remained uncommon in all groups (11.4-12.0%). Kaplan-Meier analysis demonstrated significant differences in overall survival by race (log-rank χ2 = 203.53, df = 4, p < 0.005). API patients exhibited the most favorable survival, while AI/AN patients experienced the poorest outcomes. Survival declined rapidly across all racial groups, with fewer than 20% of patients alive approximately two years after diagnosis. In multivariable Cox regression adjusting for stage at diagnosis and SES, API patients had a significantly lower risk of mortality, whereas AI/AN patients had a significantly higher risk of mortality compared with White patients. Black patients did not demonstrate a statistically significant difference in mortality after adjustment. Stage at diagnosis was the strongest predictor of survival, with localized and regional disease associated with substantially lower mortality than distant stage disease. Racial disparities in pancreatic cancer outcomes are strongly influenced by differences in stage at diagnosis. Although Black patients experienced worse unadjusted survival, this disparity was no longer significant after adjustment for stage and SES, suggesting that delayed diagnosis and socioeconomic factors account for much of the observed survival difference rather than inherent biological variation. These findings highlight the importance of improving access to timely diagnosis and equitable cancer care, particularly in underserved populations. Tahreem Malik. The impact of race, stage at diagnosis, and socioeconomic status on survival in pancreatic cancer [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr A112.