Tomita Yoko, Karapetis Christos S, Roder David, Beeke Carol, Hocking Christopher, Roy Amitesh C, Townsend Amanda R, Padbury Rob, Maddern Guy, Price Timothy J
Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
Department of Medical Oncology, Flinders Medical Centre & Flinders University, Adelaide, South Australia, Australia.
Aust J Rural Health. 2016 Apr;24(2):85-91. doi: 10.1111/ajr.12219. Epub 2015 Aug 10.
This study aims to investigate disparities in demographics, disease characteristics, treatment and overall survival between South Australian (SA) Indigenous and non-Indigenous patients with metastatic colorectal cancer (mCRC).
This employs a retrospective population study using the SA mCRC registry.
The SA mCRC registry identifies mCRC patients from hospital encounters, histopathology reports, medical oncology letters, clinician notification, attendances at multidisciplinary meetings and death audits by the SA Cancer Registry.
A total of 2865 adult mCRC patients including 14 Indigenous patients were identified through the SA mCRC registry between February 2006 and August 2013. Patients were linked to the SA Cancer Registry to obtain Indigenous status.
Demographic, disease and treatment characteristics were compared using Chi-squared test and t-test; while overall survival defined as time to any cause of death was analysed using Cox regression.
No difference was observed for clinical characteristics, except for a higher proportion of Indigenous patients receiving chemotherapy (85.7% versus 58.5%; P = 0.04). The rate of liver surgery was similar across the two groups (21.0% versus 15.1%; P = 0.40). The median overall survivals were equivalent (11.9 months versus 15.1 months; hazard ratio = 1.00; 95% confidence interval for hazard ratio, 0.54-1.86).
Clinical characteristics and survival outcomes were similar between Indigenous and non-Indigenous patients captured on the SA mCRC registry, and outcome of those who have an access to comprehensive cancer care appeared independent of Indigenous status and in line with large clinical trials. Underestimation of Indigenous cases due to their lower utilisation of cancer service could not be excluded and ultimately the accurate reporting of these patients is crucial.
本研究旨在调查南澳大利亚州（SA）转移性结直肠癌（mCRC）的原住民和非原住民患者在人口统计学、疾病特征、治疗及总生存期方面的差异。
采用回顾性人群研究，利用SA的mCRC登记册。
SA的mCRC登记册通过医院就诊记录、组织病理学报告、医学肿瘤学信函、临床医生通知、多学科会议出勤情况以及SA癌症登记处的死亡审核来识别mCRC患者。
2006年2月至2013年8月期间，通过SA的mCRC登记册共识别出2865例成年mCRC患者，其中包括14例原住民患者。患者与SA癌症登记处关联以获取原住民身份信息。
使用卡方检验和t检验比较人口统计学、疾病和治疗特征；采用Cox回归分析定义为任何原因导致死亡的时间的总生存期。
除接受化疗的原住民患者比例较高外（85.7%对58.5%；P = 0.04），未观察到临床特征的差异。两组的肝脏手术率相似（21.0%对15.1%；P = 0.40）。中位总生存期相当（11.9个月对15.1个月；风险比 = 1.00；风险比的95%置信区间为0.54 - 1.86）。
SA的mCRC登记册记录的原住民和非原住民患者的临床特征和生存结果相似，能够获得综合癌症护理的患者的结果似乎与原住民身份无关，且与大型临床试验结果一致。不能排除因原住民对癌症服务利用率较低导致病例被低估的情况，最终准确报告这些患者至关重要。
