Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York.
Department of Population Health, New York University School of Medicine, New York, New York.
Cancer. 2018 Apr 15;124(8):1791-1797. doi: 10.1002/cncr.31186. Epub 2018 Mar 12.
Although outcomes for patients with squamous cell carcinoma of the anus (SCCA) have improved, the gains in benefit may not be shared uniformly among patients of disparate socioeconomic status. In the current study, the authors investigated whether area-based median household income (MHI) is predictive of survival among patients with SCCA.
Patients diagnosed with SCCA from 2004 through 2013 in the Surveillance, Epidemiology, and End Results registry were included. Socioeconomic status was defined by census-tract MHI level and divided into quintiles. Multivariable Cox proportional hazards models and logistic regression were used to study predictors of survival and radiotherapy receipt.
A total of 9550 cases of SCCA were included. The median age of the patients was 58 years, 63% were female, 85% were white, and 38% were married. In multivariable analyses, patients living in areas with lower MHI were found to have worse overall survival and cancer-specific survival (CSS) compared with those in the highest income areas. Mortality hazard ratios for lowest to highest income were 1.32 (95% confidence interval [95% CI], 1.18-1.49), 1.31 (95% CI, 1.16-1.48), 1.19 (95% CI, 1.06-1.34), and 1.16 (95% CI, 1.03-1.30). The hazard ratios for CSS similarly ranged from 1.34 to 1.22 for lowest to highest income. Older age, black race, male sex, unmarried marital status, an earlier year of diagnosis, higher tumor grade, and later American Joint Committee on Cancer stage of disease also were associated with worse CSS. Income was not found to be associated with the odds of initiating radiotherapy in multivariable analysis (odds ratio of 0.87 for lowest to highest income level; 95% CI, 0.63-1.20).
MHI appears to independently predict CSS and overall survival in patients with SCCA. Black race was found to remain a predictor of SCCA survival despite controlling for income. Further study is needed to understand the mechanisms by which socioeconomic inequalities affect cancer care and outcomes. Cancer 2018;124:1791-7. © 2018 American Cancer Society.
尽管肛门鳞癌（SCCA）患者的预后已得到改善，但不同社会经济地位的患者的获益可能并不均等。在本研究中，作者探讨了基于地区的家庭中位数收入（MHI）是否可预测 SCCA 患者的生存情况。
纳入 2004 年至 2013 年在监测、流行病学和最终结果（SEER）登记处诊断为 SCCA 的患者。通过普查区 MHI 水平对社会经济地位进行定义，并分为五分位数。采用多变量 Cox 比例风险模型和 logistic 回归分析来研究生存和放疗接受情况的预测因素。
共纳入 9550 例 SCCA 患者。患者的中位年龄为 58 岁，63%为女性，85%为白人，38%为已婚。多变量分析显示，与收入最高地区的患者相比，收入较低地区的患者总生存率和癌症特异性生存率（CSS）更差。最低收入到最高收入的死亡率风险比分别为 1.32（95%置信区间[95%CI]，1.18-1.49）、1.31（95%CI，1.16-1.48）、1.19（95%CI，1.06-1.34）和 1.16（95%CI，1.03-1.30）。CSS 的风险比也同样在最低收入到最高收入时从 1.34 到 1.22 不等。较老的年龄、黑人种族、男性、未婚、较早年的诊断、较高的肿瘤分级和较晚的美国癌症联合委员会（AJCC）疾病分期也与较差的 CSS 相关。多变量分析中发现，收入与放疗开始的几率无关（最低收入到最高收入水平的比值比为 0.87；95%CI，0.63-1.20）。
MHI 似乎可独立预测 SCCA 患者的 CSS 和总生存率。尽管控制了收入，黑人种族仍被发现是 SCCA 生存的预测因素。需要进一步研究以了解社会经济不平等影响癌症治疗和结局的机制。癌症 2018;124:1791-7. ©2018 美国癌症协会。
