Alamanda Vignesh K, Song Yanna, Schwartz Herbert S, Holt Ginger E
Departments of *Orthopaedics and Rehabilitation †Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
Am J Clin Oncol. 2015 Dec;38(6):595-9. doi: 10.1097/COC.0000000000000004.
Racial disparities in access and survival have been reported in a variety of cancers. These issues, however, have yet to be explored in detail in patients with soft-tissue sarcomas (STS). The purpose of this paper was to investigate the independent role of race with respect to survival outcomes in STS.
A total of 7601 patients were evaluated in this study. A SEER registry query for patients over 20 years old with extremity STS diagnosed between 2004 and 2009 (n=7225) was performed. Survival outcomes were analyzed after patients were stratified by race. Multivariable survival models were used to identify independent predictors of sarcoma-specific death. The Wilcoxon rank-sum test was used to compare continuous variables. Statistical significance was maintained at P<0.05.
This study showed that African American patients were more likely to die of their STS. They were younger at presentation (P=0.001), had larger tumors (P<0.001), had less surgery (P=0.002), received radiotherapy less frequently (P=0.024), had higher family income (P<0.001), and were less likely to be married (P<0.001). African American race by itself was not an independent predictor of death.
African Americans encounter death due to STS at a much larger proportion and faster rate than their respective white counterparts. African Americans frequently present with a larger size tumor, do not undergo surgical resection, or receive radiation therapy as frequently as compared with their white peers. Barriers to timely and appropriate care should be further investigated in this group of at-risk patients.
在多种癌症中均有关于获得医疗服务及生存方面种族差异的报道。然而，这些问题在软组织肉瘤（STS）患者中尚未得到详细探究。本文旨在研究种族因素在STS生存结局方面的独立作用。
本研究共评估了7601例患者。通过监测、流行病学和最终结果（SEER）数据库查询了2004年至2009年间诊断为肢体STS的20岁以上患者（n = 7225）。在按种族对患者进行分层后分析生存结局。使用多变量生存模型来确定肉瘤特异性死亡的独立预测因素。采用Wilcoxon秩和检验比较连续变量。统计学显著性设定为P<0.05。
本研究表明，非裔美国患者死于STS的可能性更高。他们就诊时年龄更小（P = 0.001），肿瘤更大（P<0.001），接受手术的比例更低（P = 0.002），接受放疗的频率更低（P = 0.024），家庭收入更高（P<0.001），结婚的可能性更低（P<0.001）。非裔美国人这一种族本身并非死亡的独立预测因素。
与各自的白人对应人群相比，非裔美国人因STS死亡的比例更高、速度更快。与白人同龄人相比，非裔美国人经常出现更大尺寸的肿瘤，未接受手术切除或接受放疗的频率较低。对于这一高危患者群体，应进一步调查及时和适当治疗的障碍。
