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儿童肉瘤治疗与生存方面的种族和族裔差异。

Racial and ethnic disparities in treatment and survival of pediatric sarcoma.

作者信息

Jacobs Andrew J, Lindholm Erika B, Levy Carolyn Fein, Fish Jonathan D, Glick Richard D

机构信息

Hofstra Northwell School of Medicine, Hofstra University, Hempstead, New York.

Division of Pediatric Surgery, Cohen Children's Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, New York.

出版信息

J Surg Res. 2017 Nov;219:43-49. doi: 10.1016/j.jss.2017.05.031. Epub 2017 May 12.

Abstract

BACKGROUND

Childhood sarcomas are rare and require complex interdisciplinary care including surgery, chemotherapy, and radiation. The goal of this study was to determine if racial or ethnic disparities exist for pediatric sarcoma patients in the United States.

METHODS

The United States' National Cancer Institute's Surveillance, Epidemiology, and End Results database was used to identify patients aged 0-21 diagnosed with primary sarcomas from 1973 to 2012. Patients were considered by race and ethnicity. Survival curves were computed using the Kaplan-Meier method and the log-rank test.

RESULTS

A total of 11,502 patients were included in this study. When stratified by race, non-Hispanic black and Hispanic patients were significantly more likely to present with advanced stage disease than white patients. White patients were more likely to receive radiation therapy than black and Hispanic patients (P = 0.01). There was no significant difference between patients who underwent surgery (P = 0.21). Overall survival was better for white patients than black or Hispanic ones. Despite the overall 5-year survival improvement during the study period (56.2%-70.3%), survival disparities between race and ethnicity have grown.

CONCLUSIONS

Racial and ethnic disparities do exist with respect to stage, treatment, and survival of these rare tumors. Black and Hispanic patients are presenting at more advanced stage and have overall worse survival. This survival disparity has widened over the past 4 decades.

摘要

背景

儿童肉瘤较为罕见,需要包括手术、化疗和放疗在内的复杂多学科治疗。本研究的目的是确定美国小儿肉瘤患者是否存在种族或民族差异。

方法

使用美国国立癌症研究所的监测、流行病学和最终结果数据库,识别1973年至2012年期间诊断为原发性肉瘤的0至21岁患者。按种族和民族对患者进行分析。采用Kaplan-Meier方法和对数秩检验计算生存曲线。

结果

本研究共纳入11502例患者。按种族分层时,非西班牙裔黑人和西班牙裔患者比白人患者更有可能出现晚期疾病。白人患者比黑人和西班牙裔患者更有可能接受放射治疗(P = 0.01)。接受手术的患者之间没有显著差异(P = 0.21)。白人患者的总体生存率高于黑人和西班牙裔患者。尽管在研究期间总体5年生存率有所提高(从56.2%提高到70.3%),但种族和民族之间的生存差异有所扩大。

结论

在这些罕见肿瘤的分期、治疗和生存方面确实存在种族和民族差异。黑人和西班牙裔患者就诊时疾病分期更晚,总体生存率更差。这种生存差异在过去40年中有所扩大。

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