H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, United States.
H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, United States.
Cancer Epidemiol. 2016 Dec;45:18-25. doi: 10.1016/j.canep.2016.09.005. Epub 2016 Sep 22.
Patient race has been shown to predict for differences in outcomes and has been attributed to socioeconomic factors such as social support and access to healthcare. In head and neck cancer (HNC), a disease without recommended screening, we sought to investigate the association between race, treatment delays and outcome.
Records of 1802 patients with non-metastatic squamous cell HNC treated between 1998 and 2013 were retrospectively assessed from an institutional database. Patient demographics, tumor and treatment characteristics, and patient outcomes were abstracted from the chart. Differences between groups were assessed via logistic regression multivariate analysis (MVA). Outcomes including locoregional control (LRC) and overall survival (OS) were then estimated via Kaplan-Meier and Cox-regression MVA.
Median follow up was 34 months. Patient races included white (n=1671, 93%), black (n=80, 4%), Asian (n=18, 1%), and other (n=33, 2%). On logistic regression MVA, Black patients were less likely to be married (39% vs. 63%; OR 0.5 95%CI 0.30-0.83, p=0.007) or be currently employed (43% vs. 61%; OR 0.44 95%CI 0.26-0.74, p=0.002) when compared to non-blacks. Black patients were also younger (54 vs. 59 years, p=0.001), more likely to present with advanced tumor stage (T4: 48% vs. 25%), and more often had >45days elapsed from diagnosis to treatment initiation (DTI) (61% vs. 49%, p=0.028). Delays in treatment, such as delayed diagnosis (advanced disease presentation) and delays in DTI>45days were also associated with marital and employment status. Black patients were associated with a lower 3-year LRC rate (65% vs. 81%, p<0.001) and OS rate (43% vs. 69%, p<0.001), compared to non-black patients. Patients with >45days DTI had a detriment in 3-year LRC (77% vs. 83%, p=0.002) and OS (66% vs. 69%, p=0.009). On Cox MVA, black race was independently prognostic for worse LRC (HR 1.62 95%CI 1.04-2.51, p=0.033) and OS (HR 1.55 95%CI 1.15-2.08, p=0.004) vs. non-blacks.
Black race is independently prognostic for LRC and OS. Delays in HNC treatment, such as more advanced tumor stage presentation and delays in treatment initiation, may be attributed to socioeconomic factors such as employment status and social support. Efforts to accommodate these factors may expedite treatment, in hopes of improving the race related outcome disparity in HNC.
已有研究表明，患者的种族与治疗结果的差异有关，这种差异可归因于社会经济因素，如社会支持和获得医疗保健的机会。在没有推荐筛查的头颈部癌症（HNC）中，我们旨在研究种族、治疗延迟与预后之间的关系。
我们从机构数据库中回顾性评估了 1998 年至 2013 年间接受治疗的 1802 例非转移性鳞状细胞 HNC 患者的记录。从图表中提取患者人口统计学、肿瘤和治疗特征以及患者预后的数据。通过逻辑回归多变量分析（MVA）评估组间差异。然后通过 Kaplan-Meier 和 Cox 回归 MVA 估计局部区域控制（LRC）和总体生存（OS）等结果。
中位随访时间为 34 个月。患者种族包括白人（n=1671，93%）、黑人（n=80，4%）、亚洲人（n=18，1%）和其他人（n=33，2%）。在逻辑回归 MVA 中，与非黑人相比，黑人患者结婚的可能性较低（39%比 63%；OR 0.595%CI 0.30-0.83，p=0.007）或当前就业的可能性较低（43%比 61%；OR 0.4495%CI 0.26-0.74，p=0.002）。黑人患者也更年轻（54 岁比 59 岁，p=0.001），更有可能表现为晚期肿瘤分期（T4：48%比 25%），并且更有可能出现从诊断到治疗开始（DTI）的时间延迟>45 天（61%比 49%，p=0.028）。治疗延迟，如诊断延迟（晚期疾病表现）和 DTI 延迟>45 天，也与婚姻和就业状况有关。与非黑人患者相比，黑人患者的 3 年 LRC 率（65%比 81%，p<0.001）和 OS 率（43%比 69%，p<0.001）较低。DTI 超过 45 天的患者 3 年 LRC（77%比 83%，p=0.002）和 OS（66%比 69%，p=0.009）的预后较差。在 Cox MVA 中，黑人种族与 LRC（HR 1.6295%CI 1.04-2.51，p=0.033）和 OS（HR 1.5595%CI 1.15-2.08，p=0.004）的不良预后独立相关，而非黑人。
黑人种族与 LRC 和 OS 的预后独立相关。HNC 治疗的延迟，如更晚期的肿瘤分期表现和治疗开始的延迟，可能归因于社会经济因素，如就业状况和社会支持。努力适应这些因素可能会加快治疗速度，希望改善 HNC 中与种族相关的结果差异。
