Departments of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Br J Surg. 2014 Aug;101(9):1173-82. doi: 10.1002/bjs.9555. Epub 2014 Jun 11.
High socioeconomic status is associated with better survival in colorectal cancer (CRC). This study investigated whether socioeconomic status is associated with differences in surgical treatment and mortality in patients with CRC.
Patients diagnosed with stage I-III CRC between 2005 and 2010 in the Eindhoven Cancer Registry area in the Netherlands were included. Socioeconomic status was determined at a neighbourhood level by combining the mean household income and the mean value of the housing.
Some 4422 patients with colonic cancer and 2314 with rectal cancer were included. Patients with colonic cancer and high socioeconomic status were operated on with laparotomy (70·7 versus 77·6 per cent; P = 0·017), had laparoscopy converted to laparotomy (15·7 versus 29·5 per cent; P = 0·008) and developed anastomotic leakage or abscess (9·6 versus 12·6 per cent; P = 0·049) less frequently than patients with low socioeconomic status. These differences remained significant after adjustment for patient and tumour characteristics. In rectal cancer, patients with high socioeconomic status were more likely to undergo resection (96·3 versus 93·7 per cent; P = 0·083), but this was not significant in multivariable analysis (odds ratio (OR) 1·44, 95 per cent confidence interval 0·84 to 2·46). The difference in 30-day postoperative mortality in patients with colonic cancer and high and low socioeconomic status (3·6 versus 6·8 per cent; P < 0·001) was not significant after adjusting for age, co-morbidities, emergency surgery, and anastomotic leakage or abscess formation (OR 0·90, 0·51 to 1·57).
Patients with CRC and high socioeconomic status have more favourable surgical treatment characteristics than patients with low socioeconomic status. The lower 30-day postoperative mortality found in patients with colonic cancer and high socioeconomic status is largely explained by patient and surgical factors.
高社会经济地位与结直肠癌（CRC）患者的生存改善相关。本研究旨在探讨社会经济地位是否与 CRC 患者的手术治疗和死亡率差异相关。
纳入 2005 年至 2010 年间在荷兰埃因霍温癌症登记处诊断为 I-III 期 CRC 的患者。社会经济地位通过家庭收入中位数和住房价值中位数的组合，在邻里层面上进行确定。
纳入了 4422 例结肠癌患者和 2314 例直肠癌患者。社会经济地位较高的结肠癌患者接受剖腹手术的比例（70.7%与 77.6%；P=0.017）、腹腔镜转为剖腹手术的比例（15.7%与 29.5%；P=0.008）以及吻合口漏或脓肿形成的比例（9.6%与 12.6%；P=0.049）均低于社会经济地位较低的患者。在调整了患者和肿瘤特征后，这些差异仍然具有统计学意义。在直肠癌患者中，社会经济地位较高的患者更有可能接受切除术（96.3%与 93.7%；P=0.083），但多变量分析结果无统计学意义（比值比 1.44，95%置信区间 0.84 至 2.46）。在调整了年龄、合并症、急诊手术以及吻合口漏或脓肿形成后，结肠癌患者中社会经济地位较高和较低的患者 30 天术后死亡率（3.6%与 6.8%；P<0.001）差异无统计学意义（比值比 0.90，0.51 至 1.57）。
CRC 患者中社会经济地位较高的患者具有更有利的手术治疗特征，这与社会经济地位较低的患者不同。在社会经济地位较高的结肠癌患者中观察到的较低的 30 天术后死亡率主要与患者和手术因素有关。
