Department of Surgery, Duke University Medical Center, 27710, Durham, NC, USA.
J Gastrointest Surg. 2014 Jun;18(6):1194-204. doi: 10.1007/s11605-014-2515-3. Epub 2014 Apr 15.
Recently, multiple clinical trials have demonstrated improved outcomes in patients with metastatic colorectal cancer. This study investigated if the improved survival is race dependent.
Overall and cancer-specific survival of 77,490 White and Black patients with metastatic colorectal cancer from the 1988-2008 Surveillance Epidemiology and End Results registry were compared using unadjusted and multivariable adjusted Cox proportional hazard regression as well as competing risk analyses.
Median age was 69 years, 47.4 % were female and 86.0 % White. Median survival was 11 months overall, with an overall increase from 8 to 14 months between 1988 and 2008. Overall survival increased from 8 to 14 months for White, and from 6 to 13 months for Black patients. After multivariable adjustment, the following parameters were associated with better survival: White, female, younger, better educated and married patients, patients with higher income and living in urban areas, patients with rectosigmoid junction and rectal cancer, undergoing cancer-directed surgery, having well/moderately differentiated, and N0 tumors (p < 0.05 for all covariates). Discrepancies in overall survival based on race did not change significantly over time; however, there was a significant decrease of cancer-specific survival discrepancies over time between White and Black patients with a hazard ratio of 0.995 (95 % confidence interval 0.991-1.000) per year (p = 0.03).
A clinically relevant overall survival increase was found from 1988 to 2008 in this population-based analysis for both White and Black patients with metastatic colorectal cancer. Although both White and Black patients benefitted from this improvement, a slight discrepancy between the two groups remained.
最近，多项临床试验表明转移性结直肠癌患者的结局得到了改善。本研究探讨了这种改善的生存是否依赖于种族。
通过未调整和多变量调整的 Cox 比例风险回归以及竞争风险分析，比较了来自 1988-2008 年监测、流行病学和最终结果登记处的 77490 名白人和黑人转移性结直肠癌患者的总生存和癌症特异性生存。
中位年龄为 69 岁，47.4%为女性，86.0%为白人。总体中位生存期为 11 个月，1988 年至 2008 年间总体生存期从 8 个月增加到 14 个月。白人患者的总生存期从 8 个月增加到 14 个月，黑人患者从 6 个月增加到 13 个月。多变量调整后，以下参数与更好的生存相关：白人、女性、年龄较小、受教育程度较高和已婚患者、收入较高和居住在城市地区的患者、直肠乙状结肠交界处和直肠癌患者、接受癌症定向手术的患者、肿瘤分化程度较好、无淋巴结转移（所有协变量的 p 值均<0.05）。基于种族的总体生存差异随时间变化不显著，但白人和黑人患者的癌症特异性生存差异随时间显著下降，每年的危险比为 0.995（95%置信区间为 0.991-1.000）（p=0.03）。
在这项基于人群的分析中，从 1988 年到 2008 年，白人和黑人转移性结直肠癌患者的总生存均有显著改善。尽管白人和黑人患者都从这一改善中受益，但两组之间仍存在细微差异。
