Department of Surgery, University of Minnesota and Minneapolis Veterans Affairs Medical Center, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, MN 55455, USA.
Cancer. 2010 Jan 15;116(2):465-75. doi: 10.1002/cncr.24772.
Race is associated with patterns of presentation and survival outcomes of gastric cancer in the United States. However, the impact of race on the receipt of guideline-recommended care is not well characterized. By using current recommendations, the authors examined the association between race and guideline-recommended treatments and identified factors that are predictive of variations in gastric cancer care.
By using the National Cancer Database for 1998 through 2005, 106,002 patients with gastric adenocarcinoma were identified. Multivariate analysis techniques were used to examine the association between race, the receipt of guideline-recommended care, and survival after adjusting for covariates.
Although African-American and Hispanic patients were more likely to undergo adequate lymphadenectomy (> or =15 lymph nodes) and to receive care at comprehensive cancer centers and high-volume facilities (for all, P < or = .001), they were less likely to receive adjuvant multimodality therapy for American Joint Committee on Cancer stage IB through IV, lymph node-negative (M0) disease. Up to 60% of all patients who underwent gastrectomy failed to receive adequate lymphadenectomy and adjuvant multimodality therapy. The delivery of multimodality therapy varied significantly by stage and lymph node evaluation (P < or = .001). These findings persisted on our multivariate analyses, indicating that African-American and Hispanic patients received adequate lymph node evaluation (P < or = .001), whereas they were associated with receiving no adjuvant multimodality therapy (P < or = .025).
There were significant variations in treatment for gastric cancer among ethnic groups in the United States. It was noteworthy that, although nonwhite race was associated with improved surgical care, gastric cancer care remained suboptimal overall. Cancer programs need to identify procedures to maximize the delivery of adequate gastric cancer care to all patients.
在美国，种族与胃癌的表现模式和生存结果有关。然而，种族对接受指南推荐的治疗方案的影响尚未得到充分描述。作者使用目前的推荐标准，检查了种族与指南推荐的治疗方案之间的关联，并确定了预测胃癌治疗方案差异的因素。
作者使用 1998 年至 2005 年国家癌症数据库，确定了 106002 例胃腺癌患者。使用多变量分析技术，在调整了协变量后，检验了种族、接受指南推荐的治疗方案与生存之间的关联。
尽管非裔美国人和西班牙裔患者更有可能接受充分的淋巴结清扫术（≥15 个淋巴结），并在综合性癌症中心和高容量机构接受治疗（所有患者，P≤0.001），但他们更不可能接受美国癌症联合委员会分期 IB 至 IV 期、淋巴结阴性（M0）疾病的辅助多模式治疗。多达 60%的接受胃切除术的患者未能接受充分的淋巴结清扫术和辅助多模式治疗。多模式治疗的实施因分期和淋巴结评估而异（P≤0.001）。这些发现在我们的多变量分析中仍然存在，表明非裔美国人和西班牙裔患者接受了充分的淋巴结评估（P≤0.001），但他们没有接受辅助多模式治疗（P≤0.025）。
在美国的不同种族之间，胃癌的治疗方法存在显著差异。值得注意的是，尽管非白人种族与改善的手术治疗相关，但总体而言，胃癌的治疗仍然不理想。癌症项目需要确定程序，以最大限度地为所有患者提供充分的胃癌治疗。
