Tran Phu N, Taylor Thomas H, Klempner Samuel J, Zell Jason A
Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, CA, USA.
Department of Epidemiology and Genetic Epidemiology Research Institute, University of California, Irvine, CA, USA.
J Carcinog. 2017 Sep 18;16:3. doi: 10.4103/jcar.JCar_4_17. eCollection 2017.
African Americans and Hispanics are reported to have higher mortality from esophageal cancer (EC) than Caucasians. In this study, we analyzed the independent effects of race, gender, treatment, and socioeconomic status (SES) on overall survival (OS).
Data for all EC cases between 2004 and 2010 with follow-up through 2012 were obtained from the California Cancer Registry. We conducted descriptive analyses of clinical variables and survival analyses by Kaplan-Meier and Cox proportional hazards methods.
African Americans and Hispanics were more likely to be in the lower SES strata and less likely to receive surgery than Caucasians in this cohort. The proportion of patients receiving chemotherapy and radiotherapy was similar across different racial/ethnic groups. After adjustment for stage, grade, histology, treatments, and SES in multivariate analyses, the mortality risk in African Americans (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.85-1.07) and Hispanics (HR 0.96, 95% CI 0.89-1.07) did not differ from Caucasians (HR = 1.00, referent), with histology, SES, and surgery largely accounting for unadjusted OS differences. We also observed that African American men had higher adjusted risk of death relative to Caucasian men (HR 1.24, 95% CI 1.07-1.42), but this effect was not observed for African American women compared to Caucasian women (HR 1.12, 95% CI 0.94-1.35).
Race is not an independent risk factor for OS in our population-based analysis of EC cases. Rather, observed differences in OS by race/ethnicity result from differences in cancer histology, SES, surgery, and gender. Our findings support further health disparities research for this disease.
据报道，非裔美国人和西班牙裔美国人患食管癌（EC）的死亡率高于白种人。在本研究中，我们分析了种族、性别、治疗和社会经济地位（SES）对总生存期（OS）的独立影响。
从加利福尼亚癌症登记处获取2004年至2010年所有EC病例的数据，并随访至2012年。我们通过Kaplan-Meier法和Cox比例风险法对临床变量进行描述性分析和生存分析。
在该队列中，非裔美国人和西班牙裔美国人比白种人更有可能处于较低的SES阶层，接受手术的可能性更小。不同种族/族裔群体接受化疗和放疗的患者比例相似。在多变量分析中，对分期、分级、组织学、治疗和SES进行调整后，非裔美国人（风险比[HR]0.96，95%置信区间[CI]0.85-1.07）和西班牙裔美国人（HR 0.96，95%CI 0.89-1.07）的死亡风险与白种人（HR = 1.00，参照组）没有差异，组织学、SES和手术在很大程度上解释了未调整的OS差异。我们还观察到，相对于白种人男性，非裔美国男性的调整后死亡风险更高（HR 1.24，95%CI 1.07-1.42），但与白种人女性相比，非裔美国女性未观察到这种效应（HR 1.12，95%CI 0.94-1.35）。
在我们基于人群的EC病例分析中，种族不是OS的独立危险因素。相反，观察到的不同种族/族裔在OS方面的差异是由癌症组织学、SES、手术和性别的差异导致的。我们的研究结果支持对该疾病进行进一步的健康差异研究。
