Abstract A097: Impact of socioeconomic status on survival outcomes in patients with stage IV pancreatic adenocarcinoma: A race/ethnicity controlled analysis

Abstract Disparities in pancreatic ductal adenocarcinoma (PDAC) outcomes as a function of patient self-reported race or ethnicity is established. Black and Hispanic patients present more frequently with advanced-stage disease compared to White patients in part due to the disproportionate representation of patients of color in high-poverty neighborhoods with poor access to high quality care. However, race or ethnicity-based biological differences in cancer etiology cannot be ruled out. Objective: To evaluate the association between patient socioeconomic status and 5-year survival when controlling for self-reported race or ethnicity and stage of cancer. Methods: This is a retrospective study for a cohort of 2164 deidentified patients with stage 4 PDAC that received tumor genomic sequencing using the MSK-IMPACT clinical sequencing assay from March 2014 to June 2025. For each patient, the Yost index was determined using demographic and socioeconomic status (SES) data extracted from their electronic health records. Within each race/ethnicity defined patient subset, the fraction of patients that fell above or below the cohort median Yost index (relatively lower or higher SES respectively) was determined and the median overall survival for each patient fraction was compared. Results: The median Yost index for the cohort in this analysis was 15, compared to 43 across New York City (NYC), likely indicative of the economic means of a patient population seen in a tertiary cancer referral center located in the Upper East Side of NYC. Across this cohort, patients with higher relative SES had a significantly higher median overall survival, compared to patients with relatively lower SES, 9.73 versus 8.38 months, p=0.0107. Fifty seven percent of patients that self-report as non-Hispanic White for which a Yost index was determinable (NHW, n=762) fell below the cohort median Yost index (≤15). In contrast, only 15% of patients that self-report as non-Hispanic Black (NHB, n=14) and 23% of patients that self-report as Hispanic (H, n=29) had Yost indices that fell below the cohort median. Almost half of patients that self-report as non-Hispanic Asian were found to have high relative SES (48%, n=68). Importantly, NHW, NHB and H patients with higher relative SES had a better 5-year survival (NHW, 9.8 months, NHB, 8.7 months and H, 12.4) compared to whose with lower SES (NHW, 8.6 months, NHB, 7.3 months and H, 8.8). Interestingly, H patients with higher SES had a survival advantage compared to NHW or NHB patients with higher SES (12.4 months H versus 9.8 months NHW or 8.7 months NHB). For Asian patients, the difference in SES did not impact their 5-year survival rates (7.50 months Yost Index ≤15 versus 8.75 months Yost Index ≥15). Conclusion: This analysis highlights that observed race-ethnicity disparities in survival outcomes for stage IV pancreatic cancer may be driven primarily by the enrichment of patients with lower SES in communities of color, rather than inherent biological differences of cancer based factors associated with race or ethnicity. Citation Format: Amanda Erakky, Subhiksha Nandakumar, Michele Waters, Jhoely Duque-Jimenez, Afua Awuah, Maria Lao, Karthik Rangavajhula, Anna Varghese, Maria Perry, Amanda Zucker, Christopher Fong, Rose Brannon, Diana Mandelker, Nikolaus Schultz, Michael F. Berger, Christine A. Iacobuzio-Donahue, Eileen M. O'Reilly, Fiyinfolu Balogun, Debyani Chakravarty. Impact of socioeconomic status on survival outcomes in patients with stage IV pancreatic adenocarcinoma: A race/ethnicity controlled analysis abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A097.