Zhou Huaqiang, Zhang Yuanzhe, Wei Xiaoyue, Yang Kaibin, Tan Wulin, Qiu Zeting, Li Si, Chen Qinchang, Song Yiyan, Gao Shaowei
Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
Cancer Med. 2017 Nov;6(11):2745-2756. doi: 10.1002/cam4.1220. Epub 2017 Oct 4.
Pancreatic neuroendocrine tumor (pancreatic NETs), is an important cause of cancer-related death worldwide. No study has rigorously explored the impact of ethnicity on pancreatic NETs. We aimed to demonstrate the relationship between ethnicity and the survival of patients with pancreatic NETs. We used the SEER database to identify patients with pancreatic NETs from 2004 to 2013. Kaplan-Meier methods and Cox proportional hazard models were used to evaluate the impact of race on survival in pancreatic NETs patients. A total of 3850 patients were included: 3357 Non-Blacks, 493 Blacks. We stratified races as "Black" and "White/Other." Blacks were more likely to be diagnosed with later stages of tumors (P = 0.021). As for the treatment, the access to surgery seemed to be more limited in Blacks than non-Black patients (P = 0.012). Compared with non-Black patients, Black patients have worse overall survival (OS) (HR = 1.17, 95% CI: 1.00-1.37, P = 0.046) and pancreatic neuroendocrine tumors specific survival (PNSS) (HR = 1.22, 95% CI: 1.01-1.48, P = 0.044). Multivariate Cox analysis identified that disease extension at the time of diagnosis and surgical status contributed to the ethnical survival disparity. Black patients whose stages at diagnosis were localized had significantly worse OS (HR = 2.09, 95% CI: 1.18-3.71, P = 0.011) and PNSS (HR = 3.79, 95% CI: 1.62-8.82, P = 0.002). As for the patients who did not receive surgery, Blacks also have a worse OS (HR = 1.18, 95% CI: 1.00-1.41, P = 0.045). The Black patients had both worse OS and PNSS compared to non-Black patients. The restricted utilization of surgery, and the advanced disease extension at the time of diagnosis are the possible contributors to poorer survival of Blacks with pancreatic NETs.
胰腺神经内分泌肿瘤（pancreatic NETs）是全球癌症相关死亡的重要原因。尚无研究严格探讨种族对胰腺神经内分泌肿瘤的影响。我们旨在阐明种族与胰腺神经内分泌肿瘤患者生存率之间的关系。我们使用监测、流行病学和最终结果（SEER）数据库来识别2004年至2013年期间的胰腺神经内分泌肿瘤患者。采用Kaplan-Meier方法和Cox比例风险模型来评估种族对胰腺神经内分泌肿瘤患者生存的影响。共纳入3850例患者：3357例非黑人，493例黑人。我们将种族分为“黑人”和“白人/其他”。黑人更有可能被诊断为肿瘤晚期（P = 0.021）。在治疗方面，黑人接受手术的机会似乎比非黑人患者更有限（P = 0.012）。与非黑人患者相比，黑人患者的总生存期（OS）更差（风险比[HR]=1.17，95%置信区间[CI]：1.00-1.37，P = 0.046），胰腺神经内分泌肿瘤特异性生存期（PNSS）也更差（HR = 1.22，95%CI：1.01-1.48，P = 0.044）。多变量Cox分析确定，诊断时的疾病分期和手术状态导致了种族生存差异。诊断时分期为局限性的黑人患者的OS（HR = 2.09，95%CI：1.18-3.71，P = 0.011）和PNSS（HR = 3.79，95%CI：1.62-8.82，P = 0.002）明显更差。对于未接受手术的患者，黑人的OS也更差（HR = 1.18，95%CI：1.00-1.41，P = 0.045）。与非黑人患者相比，黑人患者的OS和PNSS都更差。手术利用率受限以及诊断时疾病进展较晚可能是胰腺神经内分泌肿瘤黑人患者生存率较低的原因。
