Racial and ethnic differences in pancreatic cancer survival and treatment at a high-volume center.

662 Background: Survival disparities by race and ethnicity in pancreatic cancer are often attributed to delayed access to specialized centers and differential treatment receipt. Whether these patterns persist among patients receiving care at high-volume centers remains unclear. Methods: We identified patients with pancreatic adenocarcinoma diagnosed from 2016-2024 who received chemotherapy or radiation or underwent a curative-intent pancreatectomy at an NCI-designated Comprehensive Cancer Center. Data were extracted from the institutional cancer registry, pharmacy database, and electronic health record and harmonized using Palantir Foundry. Treatment receipt by self-reported race and ethnicity was compared using chi-squared tests corrected for multiple comparisons. Cox models for overall survival (OS) and time to treatment were adjusted for age, performance status, stage at diagnosis, comorbidities, and treatment-specific variables. Results: Among 3249 patients (median follow-up 33.1 months), median OS from diagnosis across all stages was 20.7 months for non-Hispanic White (NHW), 18.6 for Hispanic, 26.6 for Asian, and 17.4 for Black patients ( p <0.001). Non-White patients were more likely to be seen within 3 months after diagnosis compared to White patients (adjusted ORs: Hispanic 1.72, Asian 2.06, Black 1.67; p <0.05 for all). Among patients with metastatic disease, receipt of chemotherapy varied across groups ( p <0.001), highest for Asian patients (92%) and lowest for Black patients (83%). Median OS from initiation of chemotherapy ranged from 9.8 months in Black patients to 11.2 months in Asian patients ( p =0.120). In patients initially diagnosed with localized disease, rates of pancreatectomy were similar: 33% for NHW, 26% for Hispanic, 28% for Asian, and 24% for Black patients ( p =0.074). Median OS after pancreatectomy was 43.9 months for NHW, 48.7 for Hispanic, 57.7 for Asian, and 39.3 for Black patients ( p =0.570). Interventional clinical trial enrollment rates were lower for Black (25%; p < 0.001) and Hispanic patients (30%; p =0.043) compared to NHW patients (38%). Post-treatment survival did not differ significantly after adjustment for first-line chemotherapy agents in patients with metastatic disease or tumor location in patients with localized disease. Conclusions: At a high-volume academic center, patients from minoritized groups receive timely evaluation and standard of care treatment at similar rates to NHW patients. Nevertheless, survival disparities persist for Black and Hispanic patients, while Asian patients experience a survival advantage. After accounting for patient and disease characteristics, survival outcomes were largely similar across groups, but lower chemotherapy rates among Black patients with metastatic disease and lower trial enrollment among Black and Hispanic patients highlight areas where treatment inequities persist.