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Differences in Baseline Characteristics and White Blood Cell Ratios Between Racial Groups in Patients with Pancreatic Adenocarcinoma

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Abstract

Purpose

Pancreatic adenocarcinoma remains a malignancy with poor prognosis. Black patients experience poorer overall survival compared with other races. Recent studies have elucidated certain prognostic factors at the time of diagnosis of pancreatic cancer which have largely not been studied for differences between racial groups. We present a study examining differences in blood levels between Black and non-Black patients and their effects on overall survival.

Methods

This is a retrospective cohort study. One hundred sixty-three patients were confirmed to carry a tissue diagnosis of pancreatic adenocarcinoma and included in analysis; 27 of the patients were self-identified as “Black”; 136 were analyzed together as “Non-Black” with the majority identifying as “White”. Various blood markers were drawn at the time of diagnosis. Kaplan-Meier and multivariable Cox regression models were used to examine differences in these factors between Black and non-Black patients, as well as their effect on overall survival.

Results

Black patients were younger at diagnosis (p = 0.001) and were more likely to experience significant weight loss leading up to diagnosis (p = 0.009); Black patients also had a lower neutrophil-to-lymphocyte ratio (NLR) (p = 0.001) and higher lymphocyte-to-monocyte ratio (LMR) (p = 0.001) at diagnosis. In multivariable analysis, an NLR > 3.5 had a significantly negative impact on overall survival (p = 0.002), as did the presence of metastatic disease (p < 0.001).

Conclusion

Black patients demonstrated a “favorable” white blood cell profile (higher LMR, lower NLR) compared with non-Black patients. This may suggest that the immune response in pancreatic adenocarcinoma is not what is driving disparately poor outcomes in Black patients. Further study is warranted to ascertain the role of immune response in pancreatic adenocarcinoma, the prognostic use of these measurements at diagnosis, and possible other factors, such as genetics, which may better explain poorer outcomes in Black patients.

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Acknowledgments

The authors would like to thank Lance K. Heilbrun, Ph.D. for his critical statistical advice.

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Authors and Affiliations

  1. Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA

    Benjamin E. Ueberroth, Adnan Khan, Kevin J. Zhang & Philip A. Philip

  2. Department of Internal Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA

    Benjamin E. Ueberroth

  3. Department of Internal Medicine, Kaiser Permanente, 3801 Howe St, Oakland, CA, 94611, USA

    Adnan Khan

  4. Department of Internal Medicine, Indiana University, 1120 W Michigan St, Indianapolis, IN, 46202, USA

    Kevin J. Zhang

  5. Barbara Ann Karmanos Cancer Institute, 4100 John R St, Detroit, MI, 48201, USA

    Philip A. Philip

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Benjamin E. Ueberroth, Adnan Khan, and Kevin Zhang. The first draft of the manuscript was written by Benjamin E. Ueberroth and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Benjamin E. Ueberroth.

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Ueberroth, B.E., Khan, A., Zhang, K.J. et al. Differences in Baseline Characteristics and White Blood Cell Ratios Between Racial Groups in Patients with Pancreatic Adenocarcinoma. J Gastrointest Canc 52, 160–168 (2021). https://doi.org/10.1007/s12029-020-00378-z

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  • DOI: https://doi.org/10.1007/s12029-020-00378-z

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