Tulane Abdominal Transplant Institute, Tulane University, New Orleans, LA 70124, USA.
Surgery. 2012 Oct;152(4):661-6; discussion 666-7. doi: 10.1016/j.surg.2012.07.008. Epub 2012 Aug 28.
The role of socioeconomic factors that affect survival, particularly for hepatocellular cancer (HCC), has yet to be fully analyzed. This study attempts to elucidate those racial and socioeconomic factors that affect differences in survival for patients with HCC.
In a retrospective cohort study of 206 patients with HCC diagnosed in an inner-city urban center from 2003 to 2011, outcomes by race (African Americans versus white) were analyzed. Additional attention was paid to socioeconomic factors. Continuous variables were compared with the Student t-test, and categorical variables were compared with the χ(2) or Fisher exact test. Multivariate analysis was conducted using a logistic regression model. Patient death and survival data were analyzed with Kaplan-Meier and Cox proportional hazards.
Comparison of 138 white and 68 African-American patients revealed that African-American patients were more likely to present with larger tumor size at the time of diagnosis (4.7 vs 3.7 cm; P < .05). African-American patients were also more likely to be intravenous drug users (25.4% vs 11.6%; P < .05) and have cirrhosis from hepatitis C (81% vs 60%; P < .01). African-American patients were less likely to have private insurance compared with white patients (68% vs 92%; P < .01). Despite these findings in our inner-city practice, there was no difference in liver transplantation rates or survival rates between the 2 groups.
Despite presentation with less-favorable tumor characteristics, African-American patients are able to achieve survival that is comparable with their white counterparts when treated in a program that is attuned to the challenges faced by their specific population.
影响生存的社会经济因素的作用，特别是对肝细胞癌（HCC），尚未得到充分分析。本研究试图阐明影响 HCC 患者生存差异的种族和社会经济因素。
在对 2003 年至 2011 年内城城市中心诊断为 HCC 的 206 例患者进行回顾性队列研究中，分析了种族（非裔美国人与白人）的结果。此外，还关注了社会经济因素。连续变量采用 Student t 检验进行比较，分类变量采用 χ(2)或 Fisher 确切检验进行比较。采用逻辑回归模型进行多变量分析。使用 Kaplan-Meier 和 Cox 比例风险分析患者死亡和生存数据。
比较了 138 名白人患者和 68 名非裔美国患者，结果显示非裔美国患者在诊断时肿瘤更大（4.7 对 3.7cm；P<.05）。非裔美国患者也更可能是静脉吸毒者（25.4%对 11.6%；P<.05），且丙型肝炎导致的肝硬化（81%对 60%；P<.01）更常见。与白人患者相比，非裔美国患者拥有私人保险的可能性更小（68%对 92%；P<.01）。尽管在我们的城市中心实践中发现了这些情况，但两组之间的肝移植率或生存率没有差异。
尽管非裔美国患者的肿瘤特征较差，但当在一个针对其特定人群面临的挑战进行调整的计划中接受治疗时，他们能够获得与白人患者相当的生存。
