Chan Chuck, Lopez Aristeo, Castaneda Garland, Bhuket Taft, Liu Benny, Yee Stephen, Irwin David, Wong Robert J
Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Hospital - Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA.
Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, USA.
J Community Health. 2017 Aug;42(4):724-729. doi: 10.1007/s10900-016-0309-0.
Colorectal cancer (CRC) remains a leading cause of morbidity and mortality in the U.S. Disparities in access to care contribute to advanced CRC stage at diagnosis, and these disparities are most pronounced among underserved populations and ethnic minorities. We aim to evaluate race/ethnicity-specific disparities in CRC stage at diagnosis among an ethnically diverse, urban safety-net hospital. We retrospectively evaluated all adult CRC patients diagnosed from January 1, 2009 to October 1, 2015. CRC cases were confirmed by histopathology specimens from biopsies and/or surgical resection. CRC staging utilized American Joint Committee on Cancer (AJCC) staging systems and were stratified by race/ethnicity. Multivariate logistic regression models were utilized to evaluate disparities in AJCC stage at presentation (stage 3-4 vs. stage 0-2). Among 311 patients with CRC [51.5% male, 25.3% black, 18.7% Hispanic, 32.0% Asian, and mean age at diagnosis 58.1 years (SD 10.3)] 61.4% had advanced ACC stage 3-4 CRC at diagnosis. Among black patients with CRC, 73.3% had AJCC stage 3-4 cancer at time of diagnosis. On multivariate regression, blacks were nearly four times more likely to have advanced AJCC stage 3-4 CRC at diagnosis compared to whites (OR 3.70; 95% CI 0.97-14.11; p = 0.055). Among a diverse underserved population, over 60% of CRC were AJCC stage 3-4 at diagnosis, and nearly 75% of blacks with CRC had AJCC stage 3-4 at diagnosis. Advanced stage CRC at diagnosis limits options for potentially curative therapies, and increases the risk for cancer recurrence and mortality.
结直肠癌（CRC）仍是美国发病和死亡的主要原因之一。获得医疗服务的差异导致诊断时结直肠癌处于晚期，而这些差异在服务不足人群和少数族裔中最为明显。我们旨在评估一家种族多样化的城市安全网医院中不同种族/族裔在结直肠癌诊断阶段的差异。我们回顾性评估了2009年1月1日至2015年10月1日期间诊断的所有成年结直肠癌患者。结直肠癌病例通过活检和/或手术切除的组织病理学标本确诊。结直肠癌分期采用美国癌症联合委员会（AJCC）分期系统，并按种族/族裔进行分层。采用多因素逻辑回归模型评估初诊时AJCC分期（3 - 4期与0 - 2期）的差异。在311例结直肠癌患者中[男性占51.5%，黑人占25.3%，西班牙裔占18.7%，亚洲人占32.0%，诊断时平均年龄58.1岁（标准差10.3）]，61.4%在诊断时患有晚期美国癌症联合委员会3 - 4期结直肠癌。在患有结直肠癌的黑人患者中，73.3%在诊断时处于AJCC 3 - 4期癌症。多因素回归分析显示，与白人相比，黑人在诊断时患有晚期AJCC 3 - 4期结直肠癌的可能性几乎高出四倍（比值比3.70；95%置信区间0.97 - 14.11；p = 0.055）。在一个多样化的服务不足人群中，超过60%的结直肠癌在诊断时处于AJCC 3 - 4期，近75%患有结直肠癌的黑人在诊断时处于AJCC 3 - 4期。诊断时处于晚期的结直肠癌限制了潜在治愈性治疗的选择，并增加了癌症复发和死亡的风险。
