Sharma Pranav, Ashouri Kenan, Zargar-Shoshtari Kamran, Luchey Adam M, Spiess Philippe E
Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
Urol Oncol. 2016 Mar;34(3):122.e9-15. doi: 10.1016/j.urolonc.2015.10.001. Epub 2015 Nov 4.
We evaluated sociodemographic and economic differences in overall survival (OS) of patients with penile SCC using the National Cancer Data Base (NCDB).
We identified 5,412 patients with a diagnosis of penile squamous cell carcinoma from 1998 to 2011 with clinically nonmetastatic disease and available pathologic tumor and nodal staging. OS was estimated using the Kaplan-Meier method, and differences were determined using the log-rank test. Cox proportional hazard regression was performed to identify independent predictors of OS.
Estimated median OS was 91.9 months (interquartile range: 25.8-not reached) at median follow-up of 44.7 months (interquartile range: 17.2-81.0). Survival did not change over the study period (P = 0.28). Black patients presented with a higher stage of disease (pT3/T4: 16.6 vs. 13.2%, P = 0.027) and had worse median OS (68.6 vs. 93.7 months, P<0.01). Patients with private insurance and median income≥$63,000 based on zip code presented with a lower stage of disease (pT3/T4: 11.6 vs. 14.7%, P = 0.002 and 12.0 vs. 14.0%, P = 0.042, respectively) and had better median OS (163.2 vs. 70.8 months, P<0.01 and 105.3 vs. 86.4 months, p = 0.001, respectively). On multivariate analysis, black race (hazard ratio [HR]: 1.39, 95% confidence interval [CI]: 1.21-1.58; P<0.01) was independently associated with worse OS, whereas private insurance (HR = 0.79, 95% CI: 0.63-0.98; P = 0.028) and higher median income≥$63,000 (HR = 0.82; 95% CI: 0.72-0.93; P = 0.001) were independently associated with better OS.
Racial and economic differences in the survival of patients with penile cancer exist. An understanding of these differences may help minimize disparities in cancer care.
我们使用国家癌症数据库（NCDB）评估阴茎鳞状细胞癌（SCC）患者总生存期（OS）的社会人口统计学和经济差异。
我们从1998年至2011年确诊的5412例阴茎鳞状细胞癌患者中，筛选出临床无转移疾病且有可用病理肿瘤和淋巴结分期的患者。采用Kaplan-Meier方法估计总生存期，并使用对数秩检验确定差异。进行Cox比例风险回归分析以确定总生存期的独立预测因素。
在中位随访44.7个月（四分位间距：17.2 - 81.0）时，估计中位总生存期为91.9个月（四分位间距：25.8 - 未达到）。在研究期间生存率没有变化（P = 0.28）。黑人患者疾病分期更高（pT3/T4：16.6%对13.2%，P = 0.027），中位总生存期更差（68.6个月对93.7个月，P<0.01）。基于邮政编码，拥有私人保险且中位收入≥63,000美元的患者疾病分期更低（pT3/T4：11.6%对14.7%，P = 0.002和12.0%对14.0%，P = 0.042），中位总生存期更好（163.2个月对70.8个月，P<0.01和105.3个月对86.4个月，P = 0.001）。多因素分析显示，黑人种族（风险比[HR]：1.39，95%置信区间[CI]：1.21 - 1.58；P<0.01）与更差的总生存期独立相关，而私人保险（HR = 0.79，95% CI：0.63 - 0.98；P = 0.028）和更高的中位收入≥63,000美元（HR = 0.82；95% CI：0.72 - 0.93；P = 0.001）与更好的总生存期独立相关。
阴茎癌患者的生存存在种族和经济差异。了解这些差异可能有助于减少癌症治疗中的差距。
