Taioli Emanuela, Wolf Andrea S, Camacho-Rivera Marlene, Kaufman Andrew, Lee Dong-Seok, Bhora Faiz, Flores Raja M
Department of Thoracic Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, New York.
Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York.
J Surg Oncol. 2016 May;113(6):659-64. doi: 10.1002/jso.24203. Epub 2016 Feb 11.
Esophageal cancer (EC) black patients have higher mortality rates than Whites. The lower rate of surgery in Blacks may explain the survival difference. We explored the Surveillance Epidemiology and End Results database to determine the impact of surgery on mortality in Blacks and Whites EC.
All cases of pathologically proven local and locoregional adenocarcinoma and squamous cell carcinoma of the esophagus from 1973 to 2011 were identified (13,678 White, 2,894 Black patients). Cervical esophageal cancer was excluded. Age, sex, diagnosis year, stage, cancer-directed surgery, radiation, and vital status were analyzed according to self-reported race.
Blacks had higher 1-year mortality, adjusted for age, sex, stage, year of diagnosis, histology, and therapy [adjusted hazard ratio (HRadj ): 1.24 (95% CI 1.16-1.32)]. Undergoing surgery was an independent predictor of improved survival overall (HRadj 0.30, 95% CI 0.27-0.33). Black patients treated surgically experienced significantly lower survival than Whites, but the difference was not observed in those who did not undergo surgery.
Although surgery appears to reduce mortality overall, early survival is worse for Blacks. Investigation into racial disparities in health care access and delivery, and to skilled esophageal surgeons is warranted to improve survival for all patients, particularly Blacks. J. Surg. Oncol. 2016;113:659-664. © 2016 Wiley Periodicals, Inc.
食管癌（EC）黑人患者的死亡率高于白人。黑人手术率较低可能解释了生存差异。我们通过监测、流行病学和最终结果数据库来确定手术对黑人和白人食管癌患者死亡率的影响。
确定1973年至2011年所有经病理证实的食管局部及区域腺癌和鳞状细胞癌病例（白人13678例，黑人2894例）。排除颈段食管癌。根据自我报告的种族分析年龄、性别、诊断年份、分期、癌症导向手术、放疗和生命状态。
校正年龄、性别、分期、诊断年份、组织学和治疗后，黑人的1年死亡率更高[校正风险比（HRadj）：1.24（95%可信区间1.16 - 1.32）]。总体而言，接受手术是生存改善的独立预测因素（HRadj 0.30，95%可信区间0.27 - 0.33）。接受手术治疗的黑人患者生存率明显低于白人，但未接受手术的患者中未观察到这种差异。
尽管手术似乎总体上可降低死亡率，但黑人患者的早期生存率较差。有必要调查医疗保健获取和提供方面以及熟练食管外科医生方面的种族差异，以提高所有患者尤其是黑人患者的生存率。《外科肿瘤学杂志》2016年；113：659 - 664。© 2016威利期刊公司
