Russell Joseph L, Chen Nai-Wei, Ortiz Shani J, Schrank Travis P, Kuo Yong-Fang, Resto Vicente A
Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch at Galveston Health, Galveston.
Biostatistics Core, Department of Preventive Medicine and Community Health, University of Texas Medical Branch at Galveston Health, Galveston.
JAMA Otolaryngol Head Neck Surg. 2014 Jun;140(6):504-12. doi: 10.1001/jamaoto.2014.406.
Several recent US studies have documented racial disparities in head and neck cancer outcomes, but few have investigated racial and ethnic differences in salivary gland cancer (SGCA) survival.
To determine whether patient race or ethnicity affects SGCA survival.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective survival analysis of all patients with SGCA from 1988 through 2010 in the Surveillance, Epidemiology, and End Results database.
Disease-specific survival according to race and ethnicity. End points assessed included age at diagnosis, sex, tumor grade, tumor size at diagnosis, extension at diagnosis, lymph node involvement at diagnosis, and treatment. Results were further analyzed by histologic subtype of SGCA.
Of 11,007 patients with SGCA, 1073 (9.7%) were black, and 1068 (9.7%), Hispanic. Whites' mean age at diagnosis was 63 years vs 53 and 52 years for blacks and Hispanics, respectively (P < .001). Twenty-year disease-specific survival rates for all SGCA histologic subtypes combined for whites, blacks, and Hispanics were 78%, 79%, and 81%, respectively. Unadjusted survival curves showed no significant difference between blacks and whites and an apparent advantage for Hispanics. However, multivariable Cox regression models controlling for patient, tumor, and treatment characteristics showed poorer disease-specific survival vs whites for blacks (hazard ratio [HR], 1.22 [95% CI, 1.03-1.46]; P = .03) but not for Hispanics (HR, 0.97 [0.79-1.19]; P = .77). The overall disease-specific survival disparity was due to poorer disease-specific survival for blacks vs whites with mucoepidermoid (P = .03) and squamous cell carcinomas (P = .05). Less surgical treatment for blacks than whites (57.26% vs 76.94%; P < .001) was a source of the survival disparity for squamous cell but not mucoepidermoid SGCA.
Black race is a risk factor for poorer disease-specific survival for patients with mucoepidermoid or squamous cell carcinoma, whereas Hispanic ethnicity has no effect. Differing treatment between black and white patients affects survival in squamous cell but not mucoepidermoid SGCA. Differences in chemotherapy treatment, comorbidities, socioeconomic status, tumor genetic factors, and environmental exposures are potential but unproven additional sources of the racial survival disparities for mucoepidermoid and squamous cell SGCA.
美国最近的几项研究记录了头颈癌治疗结果中的种族差异，但很少有研究调查唾液腺癌（SGCA）生存率的种族和民族差异。
确定患者的种族或民族是否会影响SGCA的生存率。
设计、设置和参与者：对监测、流行病学和最终结果数据库中1988年至2010年所有SGCA患者进行回顾性生存分析。
根据种族和民族划分的疾病特异性生存率。评估的终点包括诊断时的年龄、性别、肿瘤分级、诊断时的肿瘤大小、诊断时的肿瘤扩展情况、诊断时的淋巴结受累情况以及治疗情况。结果根据SGCA的组织学亚型进一步分析。
在11007例SGCA患者中，1073例（9.7%）为黑人，1068例（9.7%）为西班牙裔。白人诊断时的平均年龄为63岁，黑人和西班牙裔分别为53岁和52岁（P <.001）。白人、黑人和西班牙裔所有SGCA组织学亚型合并的20年疾病特异性生存率分别为78%、79%和81%。未调整的生存曲线显示黑人和白人之间无显著差异，西班牙裔有明显优势。然而，控制患者、肿瘤和治疗特征的多变量Cox回归模型显示，黑人的疾病特异性生存率低于白人（风险比[HR]，1.22[95%CI，1.03 - 1.46]；P =.03），而西班牙裔则无差异（HR，0.97[0.79 - 1.19]；P =.77）。总体疾病特异性生存差异是由于黑人与白人在黏液表皮样癌（P =.03）和鳞状细胞癌（P =.05）方面疾病特异性生存率较低。黑人接受手术治疗的比例低于白人（57.26%对76.94%；P <.001）是鳞状细胞癌而非黏液表皮样癌SGCA生存差异的一个原因。
黑人种族是黏液表皮样癌或鳞状细胞癌患者疾病特异性生存率较低的一个危险因素，而西班牙裔民族则无影响。黑人和白人患者在治疗上的差异影响鳞状细胞癌而非黏液表皮样癌SGCA的生存。化疗治疗、合并症、社会经济地位、肿瘤遗传因素和环境暴露方面的差异是黏液表皮样癌和鳞状细胞癌SGCA种族生存差异的潜在但未经证实的其他原因。
