Hoehn Richard S, Hanseman Dennis J, Wima Koffi, Ertel Audrey E, Paquette Ian M, Abbott Daniel E, Shah Shimul A
Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
Surgery. 2015 Nov;158(5):1244-51. doi: 10.1016/j.surg.2015.03.026. Epub 2015 May 6.
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death, and its incidence is increasing in the United States. This analysis describes the association between race, treatment decisions, operative outcomes, and survival for patients with HCC.
The National Cancer Database was queried for all patients diagnosed with HCC from 1998 to 2011 (n = 143,692) who were white (76.9%), black (14.7%), or Asian (8.4%). Multivariate logistic regression was performed to determine factors that affected the likelihood of having surgery and postoperative mortality, and a Cox regression was performed to evaluate the effect of these factors on survival.
The proportion of black patients with HCC increased in the United States during the 13-year period. There were no substantial differences among races in tumor size, grade, or overall clinical stage at the time of presentation; however, black patients were less likely to have surgery (odds ratio 0.69, 95% confidence interval 0.67-0.72). Of patients who had surgery, there were no significant differences in pathologic stage, margin negative resection rate, or 30-day mortality; however, black patients had the longest interval between diagnosis and surgery, as well as the worst overall adjusted survival (hazard ratio 1.14, 95% confidence interval 1.05-1.25). These findings were independent of HCC stage, insurance provider, and socioeconomic status.
Despite similar clinical presentation of HCC, substantial racial differences exist with regard to management and outcomes. Black patients are less likely to receive surgery for HCC and have worse long-term survival, despite similar perioperative quality metrics. This difference in long-term survival may highlight neighborhood, cultural, or biological differences between races.
肝细胞癌（HCC）是癌症相关死亡的主要原因，在美国其发病率正在上升。本分析描述了HCC患者的种族、治疗决策、手术结果和生存率之间的关联。
查询国家癌症数据库中1998年至2011年期间诊断为HCC的所有患者（n = 143,692），这些患者为白人（76.9%）、黑人（14.7%）或亚洲人（8.4%）。进行多因素逻辑回归以确定影响手术可能性和术后死亡率的因素，并进行Cox回归以评估这些因素对生存率的影响。
在这13年期间，美国黑人HCC患者的比例有所增加。在就诊时，种族之间在肿瘤大小、分级或总体临床分期方面没有实质性差异；然而，黑人患者接受手术的可能性较小（比值比0.69，95%置信区间0.67 - 0.72）。在接受手术的患者中，病理分期、切缘阴性切除率或30天死亡率没有显著差异；然而，黑人患者从诊断到手术的间隔时间最长，总体调整后的生存率也最差（风险比1.14，95%置信区间1.05 - 1.25）。这些发现独立于HCC分期、保险提供者和社会经济地位。
尽管HCC的临床表现相似，但在管理和结果方面存在显著的种族差异。黑人患者接受HCC手术的可能性较小，长期生存率较差，尽管围手术期质量指标相似。这种长期生存的差异可能突出了种族之间的社区、文化或生物学差异。
