口腔鳞状细胞癌确定性治疗选择中的种族差异。
Racial disparities in the choice of definitive treatment for squamous cell carcinoma of the oral cavity.
机构信息
Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.
出版信息
Head Neck. 2018 Nov;40(11):2372-2382. doi: 10.1002/hed.25341. Epub 2018 Jun 26.
BACKGROUND
Definitive surgery is recommended for oral cavity squamous cell carcinoma (SCC). The purpose of this study was to present our assessment of the disparities in treatment selection for oral cavity SCC.
METHODS
Non-Hispanic white and non-Hispanic black patients with oral cavity SCC were identified in the National Cancer Database (NCDB). Regression models were used to estimate relative risk (RR) of receiving surgery and absolute difference between non-Hispanic white and non-Hispanic black patients.
RESULTS
There were 82.3% of non-Hispanic white patients who received surgery, compared to 64.2% of non-Hispanic black patients (P < .001). The non-Hispanic black patients were less likely to receive surgery than non-Hispanic white patients (RR 0.87) with an absolute difference of 10.9%. The non-Hispanic black patients were significantly more likely to not be offered surgery (RR 1.42) and to refuse recommended surgery (RR 1.38) but not have a contraindication to surgery (RR 1.17).
CONCLUSION
The non-Hispanic black patients are less likely to receive or be recommended surgery for oral cavity SCC and are more likely to refuse surgery. Further study is needed to identify strategies to close this disparity.
背景
口腔鳞状细胞癌（SCC）推荐行确定性手术治疗。本研究旨在评估口腔 SCC 治疗选择的差异。
方法
在国家癌症数据库（NCDB）中确定非西班牙裔白人和非西班牙裔黑人生存口腔 SCC 的患者。采用回归模型来估计手术治疗的相对风险（RR）和非西班牙裔白人与非西班牙裔黑人患者之间的绝对差异。
结果
非西班牙裔白人患者中接受手术治疗的比例为 82.3%，而非西班牙裔黑人患者为 64.2%（P<0.001）。非西班牙裔黑人患者接受手术治疗的可能性低于非西班牙裔白人患者（RR 0.87），绝对差异为 10.9%。非西班牙裔黑人患者不太可能接受手术治疗（RR 1.42），且更可能拒绝推荐的手术治疗（RR 1.38），而不是存在手术禁忌证（RR 1.17）。
结论
非西班牙裔黑人患者接受或被建议行口腔 SCC 手术治疗的可能性较低，且更可能拒绝手术治疗。需要进一步研究以确定缩小这一差异的策略。
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