Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts.
Cancer. 2014 May 15;120(10):1532-9. doi: 10.1002/cncr.28617. Epub 2014 Feb 22.
To the authors' knowledge, it remains unknown whether race-based differences in cancer outcomes have changed with time. In the current study, the authors assessed whether racial disparities in cancer-specific mortality have improved over the last 20 years.
The Surveillance, Epidemiology, and End Results program was used to identify 2,713,474 patients diagnosed between 1988 and 2007 with either lung, breast, prostate, or colorectal cancer (the leading 3 causes of cancer-related mortality among each sex). After exclusions, 1,001,978 patients remained eligible for analysis. The impact of race on cancer-specific mortality was assessed using the regression model of Fine and Gray; an interaction model evaluated trends over time.
African Americans presented with a more advanced stage of disease (P < .001) and underwent definitive therapy less often (P < .001) than whites. After adjustment for demographics and year of diagnosis, African Americans were found to have higher estimates of cancer-specific mortality than whites for all cancers combined (hazards ratio, 1.28; 95% confidence interval, 1.26-1.30 [P < .001]) and within each individual cancer (each P < .05). These differences did not change significantly between 1988 through 1997 and 1998 through 2007, except among patients with breast cancer, in whom survival disparities increased. These findings remained significant after adjustment for stage of disease at presentation and receipt of definitive therapy (hazards ratio for breast cancer mortality in African Americans vs whites: 1.37 from 1988-1997 and 1.53 from 1998-2007; P for interaction, < .001).
The survival gap for African Americans has not closed over time. Race-based differences in outcome persist independent of stage of disease and treatment, suggesting that additional strategies beyond screening and improving access to care, such as further research into tumor biologies disproportionately affecting African Americans, are needed to improve survival for African American patients with cancer.
据作者所知，癌症结局方面的种族差异是否随时间而变化仍不清楚。本研究评估了过去 20 年来癌症特异性死亡率的种族差异是否有所改善。
利用监测、流行病学和最终结果（SEER）计划，鉴定了 1988 年至 2007 年间诊断为肺癌、乳腺癌、前列腺癌或结直肠癌的患者 2713474 例（每一种性别中癌症相关死亡率的前 3 位原因）。排除后，仍有 1001978 例患者符合分析条件。使用 Fine 和 Gray 回归模型评估种族对癌症特异性死亡率的影响；交互模型评估了随时间的趋势。
非裔美国人的疾病分期更晚（P <.001），且较少接受确定性治疗（P <.001）。调整人口统计学和诊断年份后，与白人相比，非裔美国人所有癌症的癌症特异性死亡率估计值更高（风险比为 1.28；95%置信区间为 1.26-1.30 [P <.001]），且在每种癌症中（均 P <.05）都更高。这些差异在 1988 年至 1997 年与 1998 年至 2007 年之间没有显著变化，除了乳腺癌患者的生存差异有所增加。这些发现在调整疾病分期和确定性治疗后仍然显著（非裔美国人和白人乳腺癌死亡率的风险比：1988-1997 年为 1.37，1998-2007 年为 1.53；交互 P 值，<.001）。
非裔美国人的生存差距并未随时间而缩小。与疾病分期和治疗无关，结果方面的种族差异仍然存在，这表明需要采取额外的策略，如进一步研究不成比例地影响非裔美国人的肿瘤生物学，而不仅仅是筛查和改善获得治疗的机会，以提高非裔美国癌症患者的生存率。
