Megwalu Uchechukwu C
1 Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.
Otolaryngol Head Neck Surg. 2017 Apr;156(4):665-670. doi: 10.1177/0194599817691462. Epub 2017 Feb 14.
Objective To evaluate the impact of county-level socioeconomic status on survival in patients with oropharyngeal cancer in the United States. Study Design Retrospective cohort study via a large population-based cancer database. Methods Data were extracted from the SEER 18 database (Surveillance, Epidemiology, and End Results) of the National Cancer Institute. The study cohort included 18,791 patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012. Results Patients residing in counties with a low socioeconomic status index had worse overall survival (56.5% vs 63.0%, P < .001) and disease-specific survival (62.7% vs 70.3%, P < .001) than patients residing in counties with a high socioeconomic status index. On multivariable analysis, residing in a county with a low socioeconomic status index was associated with worse overall survival (hazard ratio, 1.21; 95% CI, 1.14-1.29; P < .001) and disease-specific survival (hazard ratio, 1.21; 95% CI, 1.12-1.30; P < .001), after adjusting for race, age, sex, marital status, year of diagnosis, site, American Joint Committee on Cancer stage group, presence of distant metastasis, presence of unresectable tumor, histologic grade, surgical resection of primary site, treatment with neck dissection, and radiation therapy. Conclusion Residing in a county with a low socioeconomic status index is associated with worse survival. Further research is needed to elucidate the mechanism by which socioeconomic status affects survival in oropharyngeal cancer.
目的 评估美国县级社会经济状况对口咽癌患者生存情况的影响。研究设计 通过一个基于大人群的癌症数据库进行回顾性队列研究。方法 数据取自美国国立癌症研究所的监测、流行病学和最终结果（SEER）18数据库。研究队列包括2004年至2012年间诊断为口咽鳞状细胞癌的18791例患者。结果 社会经济状况指数较低县的患者总生存率（56.5% 对63.0%，P <.001）和疾病特异性生存率（62.7% 对70.3%，P <.001）均低于社会经济状况指数较高县的患者。多变量分析显示，在调整种族、年龄、性别、婚姻状况、诊断年份、部位、美国癌症联合委员会分期组、远处转移情况、不可切除肿瘤情况、组织学分级、原发部位手术切除、颈部清扫治疗和放射治疗后，居住在社会经济状况指数较低的县与较差的总生存率（风险比，1.21；95%可信区间，1.14 - 1.29；P <.001）和疾病特异性生存率（风险比，1.21；95%可信区间，1.12 - 1.30；P <.001）相关。结论 居住在社会经济状况指数较低的县与较差的生存率相关。需要进一步研究以阐明社会经济状况影响口咽癌患者生存的机制。
