Greenstein Alexander J, Litle Virginia R, Swanson Scott J, Divino Celia M, Packer Stuart, McGinn Thomas G, Wisnivesky Juan P
Department of General Surgery, Mount Sinai School of Medicine, New York, NY, USA.
Ann Surg Oncol. 2008 Mar;15(3):881-8. doi: 10.1245/s10434-007-9664-5. Epub 2007 Nov 7.
Blacks have a higher mortality rate than whites from esophageal cancer, but the reasons underlying this disparity remain unclear. In this study, we used a national sample of patients with resectable esophageal cancer to assess the extent to which racial inequalities in care can explain outcome disparities.
We identified all non-Hispanic white and black patients diagnosed with T0-T2, node-negative esophageal cancer between 1988 and 2003 from the Surveillance, Epidemiology, and End Results registry. Racial differences in esophageal-specific survival were assessed using the Kaplan-Meier method. We performed Cox regression to test for racial differences in survival after adjusting for potential confounders and to assess the extent to which disparities can be explained by later diagnosis or treatment inequalities.
A total of 1522 patients were included in the study. Blacks had worse esophageal-specific survival rates than whites (37% vs 60% 5-year survival; P < .0001). Blacks were more likely to be diagnosed at a more advanced stage and to have squamous cell tumors, but were less likely to undergo surgery. In multivariate regression controlling for age, sex, marital status, histology, and tumor location, black race was associated with worse survival. When tumor status, surgery, and radiotherapy were added to the model, race was no longer significantly associated with survival.
These data suggest that blacks are at greater risk of death from esophageal cancer. While the disparity is due in part to differences in tumor histology, diagnosis at an earlier stage and higher rates of surgery among blacks could reduce this survival disparity.
黑人食管癌死亡率高于白人，但这种差异背后的原因尚不清楚。在本研究中，我们使用全国可切除食管癌患者样本，以评估医疗护理方面的种族不平等在多大程度上能够解释结局差异。
我们从监测、流行病学和最终结果登记处识别出1988年至2003年间所有诊断为T0-T2、淋巴结阴性食管癌的非西班牙裔白人和黑人患者。使用Kaplan-Meier方法评估食管癌特异性生存的种族差异。我们进行Cox回归，以检验在调整潜在混杂因素后生存的种族差异，并评估差异在多大程度上可由较晚诊断或治疗不平等来解释。
本研究共纳入1522例患者。黑人的食管癌特异性生存率低于白人（5年生存率分别为37%和60%；P <.0001）。黑人更可能在较晚期被诊断出来，且患鳞状细胞肿瘤，但接受手术的可能性较小。在控制年龄、性别、婚姻状况、组织学和肿瘤位置的多变量回归中，黑人种族与较差的生存率相关。当将肿瘤状态、手术和放疗加入模型后，种族与生存率不再显著相关。
这些数据表明，黑人死于食管癌的风险更高。虽然这种差异部分归因于肿瘤组织学差异，但黑人早期诊断及更高的手术率可减少这种生存差异。
