Department of Surgery, National Defense Medical College, Saitama, Japan.
Ann Surg Oncol. 2012 May;19(5):1517-28. doi: 10.1245/s10434-011-2113-5. Epub 2011 Oct 20.
We retrospectively investigated the impact of race/ethnicity on prognosis in patients who underwent surgery for colon cancer.
Surveillance, Epidemiology, and End Results population-based data on 39,210 colon cancer patients without distant metastasis who underwent radical surgery were analyzed. Prognostic impact of race/ethnicity for non-Hispanic white, Hispanic white, African American, and East Asian (Japanese, Chinese, Korean) American patients, and confounding factors of age, sex, registry region, year of diagnosis, tumor, node, metastasis system stage, tumor grade, tumor site, and the number of lymph nodes examined were analyzed by the Cox proportional hazard model. The lymph node count was analyzed and adjusted means were calculated by a generalized multiple regression model with respect to race and other factors.
Significant differences due to race/ethnicity were observed in crude hazard ratios with respect to overall and colon cancer-specific mortality, which persisted even after adjusting for confounding factors. Adjusted hazard ratios of colon cancer-specific mortality for non-Hispanic white, Hispanic white, African American, and East Asian American patients were 1 (reference), 1.01 (95% confidence interval 0.91-1.12), 1.40 (95% confidence interval 1.31-1.50), and 0.83 (95% confidence interval 0.74-0.94), respectively. There were significant differences in crude number of lymph nodes examined among races, which were no longer significant after adjusting for covariates.
East Asian American patients had significantly better prognosis, while African American patients had worse prognosis than non-Hispanic white patients, despite the identical adjusted number of lymph nodes examined after surgery for colon cancer. This disparity in prognosis among races/ethnicities should be taken into consideration when deciding adjuvant chemotherapy for nonwhite patients.
我们回顾性研究了种族/民族对接受结肠癌根治性手术患者预后的影响。
分析了无远处转移的 39210 例接受根治性手术的结肠癌患者的监测、流行病学和最终结果人群数据。通过 Cox 比例风险模型分析非西班牙裔白人、西班牙裔白人、非裔美国人和东亚（日本、中国、韩国）美国人患者的种族/民族的预后影响，以及年龄、性别、登记区域、诊断年份、肿瘤、淋巴结、转移系统分期、肿瘤分级、肿瘤部位和检查的淋巴结数量等混杂因素。通过广义多重回归模型分析与种族相关的淋巴结计数和调整平均值，并考虑其他因素。
尽管调整了混杂因素，但种族/民族之间在总体和结肠癌特异性死亡率的粗风险比方面仍存在显著差异。非西班牙裔白人、西班牙裔白人、非裔美国人和东亚裔美国人的结肠癌特异性死亡率的调整风险比分别为 1（参考）、1.01（95%置信区间 0.91-1.12）、1.40（95%置信区间 1.31-1.50）和 0.83（95%置信区间 0.74-0.94）。种族之间的粗淋巴结检查数量存在显著差异，但在调整了协变量后，这种差异不再显著。
尽管东亚裔美国人的术后检查淋巴结数量与非西班牙裔白人相同，但与非西班牙裔白人相比，东亚裔美国人的预后明显更好，而非裔美国人的预后更差。在决定非白人患者接受辅助化疗时，应考虑这种种族间的预后差异。
