Barclay Karen L, Goh Paul-Jon, Jackson Terri J
Department of Surgery, The Northern Hospital, Melbourne, Victoria, Australia; Department of Surgery, School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
ANZ J Surg. 2015 Mar;85(3):135-9. doi: 10.1111/ans.12709. Epub 2014 Jun 6.
Colorectal cancer (CRC) is common, and early diagnosis improves outcome. Overseas studies have suggested that low socio-economic status (SES) is related to advanced cancer stage at presentation and reduced survival. The situation in Australia is unclear. This study examines the effect of demographic and SES on CRC stage at presentation and survival in a single tertiary centre.
Patients undergoing surgical resection for CRC (1 January 2005 to 31 December 2010) were identified, and socio-demographic and histopathological information obtained. Four socio-economic indices using 2006 Australian Census data were assigned by residential postcode. Factors contributing to tumour (T) and American Joint Committee on Cancer (AJCC) stage at presentation and survival were assessed.
Five hundred and fifty-seven patients were included. Results did not support a relationship between SES and either advanced stage at presentation or survival. Only one index (economic resources) was related to a more advanced T stage at presentation (P = 0.011); none were related to AJCC stage or survival. No significant relationship was found between an individual's country of birth, language spoken, private insurance or employment status and presenting with a later T or AJCC stage. Age, AJCC and T stage at diagnosis and emergency presentation significantly affected survival on multivariate analysis.
SES and most demographic factors did not appear to significantly influence CRC stage at presentation and outcome. A focus on obtaining equivalent access to health care both nationally and internationally could prove beneficial in improving outcomes for CRC.
结直肠癌（CRC）很常见，早期诊断可改善预后。海外研究表明，社会经济地位（SES）较低与就诊时癌症晚期及生存率降低有关。澳大利亚的情况尚不清楚。本研究在一个单一的三级中心探讨了人口统计学和SES对CRC就诊时分期及生存的影响。
确定2005年1月1日至2010年12月31日期间接受CRC手术切除的患者，并获取社会人口统计学和组织病理学信息。根据居住邮政编码，使用2006年澳大利亚人口普查数据分配四个社会经济指数。评估影响就诊时肿瘤（T）分期和美国癌症联合委员会（AJCC）分期及生存的因素。
纳入557例患者。结果不支持SES与就诊时晚期或生存之间存在关联。仅一个指数（经济资源）与就诊时更高级别的T分期相关（P = 0.011）；均与AJCC分期或生存无关。未发现个人的出生国家、所讲语言、私人保险或就业状况与更晚的T分期或AJCC分期就诊之间存在显著关联。多因素分析显示，年龄、诊断时的AJCC和T分期以及急诊就诊显著影响生存。
SES和大多数人口统计学因素似乎并未显著影响CRC就诊时的分期及预后。在国内和国际上致力于获得同等的医疗保健服务可能对改善CRC的预后有益。
