Wong Ting Hway, Skanthakumar Thakshayeni, Nadkarni Nivedita, Nguyen Hai Van, Iyer N Gopalakrishna
Department of General Surgery, Singapore General Hospital, Singapore.
Duke-National University of Singapore Medical School, Singapore.
Cancer. 2017 Jun 1;123(11):1998-2005. doi: 10.1002/cncr.30557. Epub 2017 Jan 30.
Socioeconomic status affects survival in patients diagnosed with head and neck squamous cell carcinoma (HNSCC), even in health systems with universal health care. Singapore has a tiered subsidized housing system, in which income determines eligibility for subsidies by size of apartment. The objective of this study was to assess whether a patient's residential type (small/heavily subsidized, medium/moderate subsidy, large/minimal or no subsidy) influenced mortality. A secondary analysis examined whether patients in smaller subsidized apartments were more likely to present with advanced disease.
An historical cohort study of patients in a tertiary referral center with HNSCC was identified in the multidisciplinary cancer database from 1992 to 2014. Clinicopathologic data were extracted for analysis. Patient residential postal codes were matched to type of housing. Logistic regression was performed to evaluate the relationship between all-cause mortality and the predictors of interest as well as the association between housing type and disease stage at presentation.
Of the 758 patients identified, most were men (73.4%), the median age was 64 years, 30.5% and 15.2% were smokers and former smokers, respectively. Over one-half (56.8%) of patients presented with advanced disease. Male gender, age, stage at presentation, survival time from diagnosis, and smoker status were significant predictors of mortality. Patients living in the smaller, higher subsidy apartments had poorer survival, although they were not more likely to present with advanced disease, suggesting that the survival difference was not because of delayed presentation.
Patients with HNSCC living in smaller, higher-subsidy apartments have poorer survival despite no apparent delays in presentation. Cancer 2017;123:1998-2005. © 2017 American Cancer Society.
社会经济地位会影响头颈部鳞状细胞癌（HNSCC）患者的生存情况，即便在实行全民医保的卫生系统中亦是如此。新加坡有一套分级补贴住房系统，收入决定了根据公寓面积获得补贴的资格。本研究的目的是评估患者的居住类型（小面积/高额补贴、中等面积/适度补贴、大面积/极少或无补贴）是否会影响死亡率。一项二次分析检验了居住在较小补贴公寓中的患者是否更有可能出现晚期疾病。
在多学科癌症数据库中确定了1992年至2014年在一家三级转诊中心就诊的HNSCC患者的历史队列研究。提取临床病理数据进行分析。将患者居住邮政编码与住房类型进行匹配。进行逻辑回归以评估全因死亡率与感兴趣的预测因素之间的关系，以及住房类型与就诊时疾病分期之间的关联。
在确定的758例患者中，大多数为男性（73.4%），中位年龄为64岁，吸烟者和既往吸烟者分别占30.5%和15.2%。超过一半（56.8%）的患者出现晚期疾病。男性、年龄、就诊时分期、诊断后的生存时间和吸烟状况是死亡率的显著预测因素。居住在面积较小、补贴较高公寓中的患者生存较差，尽管他们出现晚期疾病的可能性并不更高，这表明生存差异并非由于就诊延迟所致。
居住在面积较小、补贴较高公寓中的HNSCC患者生存较差，尽管就诊时无明显延迟。《癌症》2017年；123：1998 - 2005。©2017美国癌症协会。
