Kim Jason D, Firouzbakht Aryan, Ruan Jenny Y, Kornelsen Emily, Moghaddamjou Ali, Javaheri Khodadad R, Olson Robert A, Cheung Winson Y
Department of Medicine, Division of Medical Oncology, University of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
Department of Oncology, Division of Medical Oncology, University of Calgary, Tom Baker Cancer Center, Calgary, Alberta, Canada.
Laryngoscope. 2018 Apr;128(4):852-858. doi: 10.1002/lary.26836. Epub 2017 Sep 20.
OBJECTIVES/HYPOTHESIS: To assess for potential urban and rural disparities in head and neck cancer (HNC) outcomes within a single-payer healthcare system.
A large retrospective population-based cohort analysis of consecutive HNC patients treated in British Columbia, Canada between 2001 and 2010 was conducted.
All patients diagnosed with HNC from 2001 to 2010 and referred to any one of five British Columbia Cancer Agency centers for management were reviewed. Based on census data, patients were classified into: 1) rural, 2) small urban, 3) moderate urban, and 4) large urban areas. Kaplan-Meier methods and Cox regression models were used to correlate site of residence with overall survival (OS), controlling for prognostic factors that included sociodemographic and other tumor and treatment-related characteristics.
We identified 3,036 patients; the median age was 64 years, 26% were women, and 32% had Eastern Cooperative Oncology Group (ECOG) 0 or 1. The majority resided in large urban areas (55%) followed by rural (22%), moderate urban (13%), and small urban (10%). In regression analyses, smoking (hazard ratio [HR]: 2.10, 95% confidence interval [CI]: 1.28-3.45, P < .001), ECOG 2 + (HR: 3.44, 95% CI: 2.26-5.22, P < .001), oral cavity (HR: 1.54, 95% CI: 1.03-2.32, P = .04) and hypopharyngeal tumors (HR: 2.31, 95% CI: 1.42-3.77, P = .00), and large tumor size (HR: 1.69, 95% CI: 1.08-2.64, P = .02) were correlated with inferior OS, but site of residence was not. When stratified by type of treatment, OS remained similar irrespective of urban or rural residence.
Urban-rural differences in HNC survival outcomes were not observed.
2c. Laryngoscope, 128:852-858, 2018.
目的/假设：评估单一支付者医疗体系中头颈癌（HNC）治疗结果在城乡之间的潜在差异。
对2001年至2010年期间在加拿大不列颠哥伦比亚省接受治疗的连续性HNC患者进行了一项基于人群的大型回顾性队列分析。
对2001年至2010年期间被诊断为HNC并转诊至不列颠哥伦比亚癌症机构五个中心之一进行治疗的所有患者进行了评估。根据人口普查数据，将患者分为：1）农村，2）小城市，3）中等城市，4）大城市地区。采用Kaplan-Meier方法和Cox回归模型将居住地点与总生存期（OS）进行关联，并对包括社会人口统计学以及其他肿瘤和治疗相关特征在内的预后因素进行控制。
我们共纳入3036例患者；中位年龄为64岁，26%为女性，32%的东部肿瘤协作组（ECOG）评分为0或1。大多数患者居住在大城市地区（55%），其次是农村（22%）,中等城市（13%）和小城市（10%）。在回归分析中，吸烟（风险比[HR]：2.10，95%置信区间[CI]：1.28 - 3.45，P <.001）、ECOG 2 +（HR：3.44，95% CI：2.26 - 5.22，P <.001）、口腔癌（HR：1.54，95% CI：1.03 - 2.32，P = 0.04）和下咽肿瘤（HR：2.31，95% CI：1.42 - 3.77，P = 0.00）以及肿瘤体积较大（HR：1.69，95% CI：1.08 - 2.64，P = 0.02）与较差的总生存期相关，但居住地点与之无关。按治疗类型分层时，无论城乡居住情况如何，总生存期均相似。
未观察到头颈癌生存结果的城乡差异。
2c。《喉镜》，128:852 - 858，2018年。
