剖析局部区域性胰腺癌患者治疗中的种族差异：两步法。
Dissecting racial disparities in the treatment of patients with locoregional pancreatic cancer: a 2-step process.
机构信息
Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0542, USA.
出版信息
Cancer. 2010 Feb 15;116(4):930-9. doi: 10.1002/cncr.24836.
BACKGROUND
Previous studies have demonstrated that black patients with pancreatic cancer are less likely to undergo resection and have worse overall survival compared with white patients. The objective of this study was to determine whether these disparities occur at the point of surgical evaluation or after evaluation has taken place.
METHODS
The authors used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data (1992-2002) to compare black patients and white patients with locoregional pancreatic cancer in univariate models. Logistic regression was used to determine the effect of race on surgical evaluation and on surgical resection after evaluation. Cox proportional hazards models were used to identify which factors influenced 2-year survival.
RESULTS
Nine percent of 3777 patients were black. Blacks were substantially less likely than whites to undergo evaluation by a surgeon (odds ratio, 0.57; 95% confidence interval, 0.42-0.77) when the model was adjusted for demographics, tumor characteristics, surgical evaluation, socioeconomic status, and year of diagnosis. Patients who were younger and who had fewer comorbidities, abdominal imaging, and a primary care physician were more likely to undergo surgical evaluation. Once they were seen by a surgeon, blacks still were less likely than whites to undergo resection (odds ratio, 0.64; 95% confidence interval, 0.49-0.84). Although black patients had decreased survival in an unadjusted model, race no longer was significant after accounting for resection.
CONCLUSIONS
Twenty-nine percent of black patients with potentially resectable pancreatic cancers never received surgical evaluation. Without surgical evaluation, patients cannot make an informed decision and will not be offered resection. Attaining higher rates of surgical evaluation in black patients would be the first step to eliminating the observed disparity in the resection rate.
背景
先前的研究表明，与白人患者相比，黑人胰腺癌患者接受切除术的可能性较小，总体生存率也较差。本研究旨在确定这些差异是在手术评估前还是评估后发生的。
方法
作者使用监测、流行病学和最终结果（SEER）-医疗保险关联数据（1992-2002 年），在单变量模型中比较局部区域胰腺癌的黑人和白人患者。使用逻辑回归确定种族对手术评估以及评估后手术切除的影响。使用 Cox 比例风险模型确定影响 2 年生存率的因素。
结果
3777 名患者中有 9%为黑人。调整人口统计学、肿瘤特征、手术评估、社会经济状况和诊断年份后，黑人接受外科医生评估的可能性明显低于白人（比值比，0.57；95%置信区间，0.42-0.77）。年龄较小、合并症较少、腹部影像学检查和初级保健医生较多的患者更有可能接受手术评估。一旦他们接受了外科医生的检查，黑人接受切除术的可能性仍低于白人（比值比，0.64；95%置信区间，0.49-0.84）。尽管在未调整模型中黑人患者的生存率较低，但在考虑到切除术之后，种族因素不再显著。
结论
29%的潜在可切除胰腺癌黑人患者从未接受过手术评估。如果没有手术评估，患者就无法做出明智的决定，也不会被提供切除术。提高黑人患者的手术评估率将是消除观察到的切除术率差异的第一步。
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