Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD).
J Natl Cancer Inst. 2015 Mar 20;107(6):djv054. doi: 10.1093/jnci/djv054. Print 2015 Jun.
Racial disparities in cancer survival outcomes have been primarily attributed to underlying biologic mechanisms and the quality of cancer care received. Because prior literature shows little difference exists in the socioeconomic status of non-Hispanic whites and Asian Americans, any difference in cancer survival is less likely to be attributable to inequalities of care. We sought to examine differences in cancer-specific survival between whites and Asian Americans.
The Surveillance, Epidemiology, and End Results Program was used to identify patients with lung (n = 130 852 [16.9%]), breast (n = 313 977 [40.4%]), prostate (n = 166 529 [21.4%]), or colorectal (n = 165 140 [21.3%]) cancer (the three leading causes of cancer-related mortality within each sex) diagnosed between 1991 and 2007. Fine and Gray's competing risks regression compared the cancer-specific mortality (CSM) of eight Asian American groups (Chinese, Filipino, Hawaiian/Pacific Islander, Japanese, Korean, other Asian, South Asian [Indian/Pakistani], and Vietnamese) to non-Hispanic white patients. All P values were two-sided.
In competing risks regression, the receipt of definitive treatment was an independent predictor of CSM (hazard ratio [HR] = 0.37, 95% confidence interval [CI] = 0.35 to 0.40; HR = 0.55, 95% CI = 0.53 to 0.58; HR = 0.61, 95% CI = 0.60 to 0.62; and HR = 0.27, 95% CI = 0.25 to 0.29) for prostate, breast, lung, and colorectal cancers respectively, all P < .001). In adjusted analyses, most Asian subgroups (except Hawaiians and Koreans) had lower CSM relative to white patients, with hazard ratios ranging from 0.54 (95% CI = 0.38 to 0.78) to 0.88 (95% CI = 0.84 to 0.93) for Japanese patients with prostate and Chinese patients with lung cancer, respectively.
Despite adjustment for potential confounders, including the receipt of definitive treatment and tumor characteristics, most Asian subgroups had better CSM than non-Hispanic white patients. These findings suggest that underlying genetic/biological differences, along with potential cultural variations, may impact survival in Asian American cancer patients.
癌症生存结果的种族差异主要归因于潜在的生物学机制和所接受的癌症护理质量。由于先前的文献表明非西班牙裔白人和亚裔美国人的社会经济地位几乎没有差异，因此癌症生存方面的任何差异不太可能归因于护理不平等。我们试图研究白人和亚裔美国人之间的癌症特异性生存率差异。
利用监测、流行病学和最终结果计划（Surveillance, Epidemiology, and End Results Program），确定了 1991 年至 2007 年间诊断患有肺癌（n = 130852 [16.9%]）、乳腺癌（n = 313977 [40.4%]）、前列腺癌（n = 166529 [21.4%]）或结直肠癌（n = 165140 [21.3%]）的患者，这些癌症是每个性别中与癌症相关的死亡率最高的三种癌症。Fine 和 Gray 的竞争风险回归比较了八个亚裔群体（中国人、菲律宾人、夏威夷/太平洋岛民、日本人、韩国人、其他亚洲人、南亚人[印度/巴基斯坦人]和越南人）的癌症特异性死亡率（CSM）与非西班牙裔白人患者的 CSM。所有 P 值均为双侧。
在竞争风险回归中，确定性治疗的获得是 CSM 的独立预测因子（危险比 [HR] = 0.37，95%置信区间 [CI] = 0.35 至 0.40；HR = 0.55，95% CI = 0.53 至 0.58；HR = 0.61，95% CI = 0.60 至 0.62；HR = 0.27，95% CI = 0.25 至 0.29），分别用于前列腺癌、乳腺癌、肺癌和结直肠癌，所有 P 值均<.001）。在调整后的分析中，大多数亚裔亚组（夏威夷人和韩国人除外）的 CSM 相对白人患者较低，日本人的前列腺癌和中国人的肺癌患者的危险比分别为 0.54（95%CI = 0.38 至 0.78）和 0.88（95%CI = 0.84 至 0.93）。
尽管调整了潜在的混杂因素，包括确定性治疗的获得和肿瘤特征，但大多数亚裔亚组的 CSM 优于非西班牙裔白人患者。这些发现表明，潜在的遗传/生物学差异以及潜在的文化差异可能会影响亚裔美国癌症患者的生存。
