Department of Surgery, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
Int J Colorectal Dis. 2012 Jun;27(6):737-49. doi: 10.1007/s00384-011-1378-2. Epub 2011 Dec 10.
Race/ethnicity may modify cancer outcomes and manifest as survival disparities for patients with rectal cancer. Our objective was to determine whether disparate rectal cancer outcomes result from variable efficacy of radiation therapy for major racial/ethnic groups.
The Los Angeles County Cancer Surveillance Program (CSP) identified patients with rectal adenocarcinoma between the years 1988 and 2006. Patients who underwent curative-intent surgery were grouped by race/ethnicity and by receipt (yes vs. no) and timing (neoadjuvant vs. adjuvant) of radiation therapy. The impact of receipt and timing of radiation therapy on overall survival was then assessed.
Of 4,961 patients in CSP, 2,229 (45%) received radiation therapy. Overall, there was no difference in survival among patients according to receipt of radiation therapy. We then examined the radiation cohort, wherein 919 (41%) and 1,310 (59%) patients received neoadjuvant or adjuvant radiation, respectively. Overall, patients who received neoadjuvant compared to adjuvant radiation had improved survival (median survival (MS), 9.4 vs. 6.8 years, respectively; p < 0.001). Among those patients who received neoadjuvant radiation, whites, Hispanics, and Asians had significantly longer survival than blacks (MS, 10.4, 10.4, and 10.4 vs. 4.4 years, respectively; p = 0.003). On multivariate analysis, race/ethnicity was an independent predictor of survival (p = 0.001).
To our knowledge, this is the first study examining the efficacy of radiation therapy for racial/ethnic groups with rectal cancer. Disparate outcomes were observed for the administration of radiation therapy for select racial/ethnic groups. The reasons for these disparities in outcomes should be investigated to better optimize radiation therapy for patients with rectal cancer.
种族/民族可能会影响癌症的结果，并表现为直肠癌患者的生存差异。我们的目的是确定主要种族/民族群体之间的放疗效果不同是否导致直肠癌结果的差异。
洛杉矶县癌症监测计划（CSP）确定了 1988 年至 2006 年间患有直肠腺癌的患者。根据种族/民族以及是否接受（是与否）和时间（新辅助与辅助）接受放疗，将接受根治性手术的患者分组。然后评估放疗的接受和时间对总生存率的影响。
在 CSP 的 4961 名患者中，有 2229 名（45%）接受了放疗。总体而言，根据是否接受放疗，患者的生存没有差异。然后我们检查了放疗队列，其中 919 名（41%）和 1310 名（59%）患者分别接受了新辅助或辅助放疗。总体而言，接受新辅助放疗的患者比接受辅助放疗的患者生存时间更长（中位生存期（MS），分别为 9.4 年和 6.8 年，分别为；p<0.001）。在接受新辅助放疗的患者中，白人、西班牙裔和亚洲人的生存时间明显长于黑人（MS，分别为 10.4、10.4 和 10.4 年和 4.4 年，分别为；p=0.003）。多变量分析显示，种族/民族是生存的独立预测因素（p=0.001）。
据我们所知，这是第一项研究，研究了放疗对直肠癌不同种族/民族群体的疗效。对于某些种族/民族群体，放疗的管理效果存在差异。应该调查这些结果差异的原因，以更好地为直肠癌患者优化放疗。
