Department of Surgery, University of Arizona, Tucson, AZ, USA.
J Am Coll Surg. 2011 Oct;213(4):469-74. doi: 10.1016/j.jamcollsurg.2011.05.026. Epub 2011 Jul 1.
Minority groups with colorectal cancer have not experienced the decline in incidence and mortality that has been reported in whites. We sought to determine whether differences exist in treatment and survival between white and Native American patients with colorectal cancer because little has been written about this specific minority group.
The Surveillance Epidemiology and End Results (SEER) database for colorectal cancer was used to compare treatment and survival in whites (colon, n = 137,949; rectum, n = 46,843) and Native Americans (colon, n = 872; rectum, n = 316). Cox proportional hazards models were used to compare cancer-specific survival in Native Americans with whites, adjusted for stage, sex, age and year of diagnosis, socioeconomic status, and treatment.
Native Americans presented at younger ages than whites for both colon and rectal cancer (p < 0.001). They were diagnosed at more advanced stages of disease than whites for only colon cancer. No significant differences were detected in the proportion of patients recommended for surgery between the two groups, for either cancer at any stage (all p > 0.05). Native Americans with rectal cancer were more likely to receive radiation than whites (p < 0.001), but they received less sphincter-preserving surgery (60.0% vs 65.4%; p = 0.045). Native Americans with colon cancer fared significantly worse than whites (hazard ratio = 1.20; 95% CI = 1.08 to 1.34), but there is no difference in cancer-free survival between races for rectal cancer.
Compared with whites, Native Americans with colon cancer have worse cancer-specific survival.
少数族裔群体的结直肠癌发病率和死亡率并未像白人那样下降。我们试图确定白人患者和美国原住民患者在结直肠癌的治疗和生存方面是否存在差异，因为关于这个特定的少数族裔群体的研究很少。
使用监测、流行病学和最终结果（SEER）数据库比较白人（结肠癌，n=137949；直肠癌，n=46843）和美国原住民（结肠癌，n=872；直肠癌，n=316）的治疗和生存情况。使用 Cox 比例风险模型比较美国原住民和白人的癌症特异性生存率，调整了分期、性别、年龄和诊断年份、社会经济状况和治疗因素。
美国原住民在结肠癌和直肠癌的发病年龄都比白人小（p<0.001）。他们在结肠癌方面被诊断为更晚期的疾病，而在直肠癌方面则没有比白人更晚期。在任何分期的两种癌症中，建议手术的患者比例在两组之间没有显著差异（所有 p>0.05）。接受放疗的直肠癌美国原住民比白人更常见（p<0.001），但他们接受保肛手术的比例较低（60.0%比 65.4%；p=0.045）。与白人相比，美国原住民的结肠癌患者预后明显较差（风险比=1.20；95%CI=1.08 至 1.34），但直肠癌患者的无癌生存率在种族之间没有差异。
与白人相比，美国原住民的结肠癌患者癌症特异性生存率较差。
