E116: Unmasking Disparities in Gallbladder Cancer Outcomes in the Disaggregated Asian American Population

Gallbladder cancer (GBC) is an aggressive cancer with a high mortality rate. Patients often present with advanced-stage disease, likely due to its asymptomatic presentation and aggressive tumor biology. Higher rates of disease have been found in Asian populations as compared to the Western population. The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population is among the fastest-growing populations in the United States. However, this is not reflected in scientific research, in which ethnic groups are often combined. We identified trends in treatment and outcomes for gallbladder cancer in a disaggregated AANHPI population.

Methods:

We performed a retrospective analysis of the National Cancer Database (NCDB) between 2010-2019, examining all patients treated for gallbladder cancer. We identified basic demographic factors for patients of Caucasian, African American, and disaggregated Asian subpopulations. Survival curves were used to identify differences in median overall survival, and a multivariate analysis was performed to help determine which factors impact overall survival.


Results:

25,568 patients met the inclusion criteria, of which 1,317 (5%) were Asian American (AA). The median survival time for the overall AA population is 15.1 months, as compared to Caucasian (11.5 months) and African American (11.4 months) populations (P< 0.0001).  Within the AANHPI groups, the Korean subpopulation is noted to have the lowest survival time at 12.6 months, while Filipinos have the longest survival at 19.1 months (p < 0.0001). We identified different trends in socioeconomic and treatment characteristics between groups. Of note, patients of Filipino descent had the highest rate of surgical resection but lower chemotherapy utilization. Conversely, Korean patients had the highest utilization of multimodality therapy. Multivariate analysis demonstrated belonging to Filipino ethnicity was associated with a decreased mortality risk.


Conclusions:

Significant differences were identified in the overall median survival for patients with gallbladder cancer between AANHPI subpopulations. We found important differences based on socioeconomic factors that may explain some variations in survival. However, our finding that Filipino patients had increased survival with the lowest rate of systemic therapy usage suggests that underlying genetic and epigenetic factors mediate these differences. This study highlights the need to include disaggregated data in future studies to subdue disparities in cancer care for patients.