Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas.
Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas.
Clin Gastroenterol Hepatol. 2019 Mar;17(4):657-665.e13. doi: 10.1016/j.cgh.2018.07.018. Epub 2018 Jul 20.
BACKGROUND & AIMS: There are racial disparities in survival times of patients with esophageal cancer. We examined the sequential effects of characteristics, diagnosis, and treatment-related factors on the disparity in survival times of black vs white patients with esophageal cancer.
We identified 1900 black and 15,523 non-Hispanic white (NHW) patients, 65 years or older, diagnosed with esophageal squamous cell carcinoma or esophageal adenocarcinoma from 1994 through 2011 in the Surveillance Epidemiology and End Results (SEER)-Medicare database. Patients were followed up until death or December 31, 2012. Three sets of 1900 NHW patients were matched sequentially to the same set of 1900 black patients, based on demographics (age, sex, year of diagnosis, and SEER site), presentation (demographics plus cancer stage, grade, and comorbidity), and treatment (presentation variables plus surgery, chemotherapy, or radiation therapy).
The absolute difference in 5-year survival between black patients (13.3%) and NHW patients (18.4%) was 5.1% (95% CI, 2.3%-7.7%; P = .001) in the demographics match. After we matched for presentation, the difference in 5-year survival was reduced to 2.3% (95% CI, 0.3%-4.8%), but remained statistically significant (P = .04). Additional matching of patients on treatment-related factors eliminated the racial difference in 5-year survival (P = .59). Among patients matched for disease presentation, only 10.8% of black patients underwent surgery, compared with 22.8% of NHW patients (P < .001). Histology, tumor location, socioeconomic status, chemotherapy, and radiation therapy each were associated with the receipt of surgery. None of these factors, however, could explain the racial difference in the receipt of surgery.
In the SEER-Medicare database, underuse of surgical treatment can account for the disparities in survival times between black and NHW patients with esophageal cancer.
在食管癌患者的生存时间方面存在种族差异。我们研究了特征、诊断和治疗相关因素对黑人和白人食管癌患者生存时间差异的先后影响。
我们从 1994 年至 2011 年的监测、流行病学和最终结果（SEER）-医疗保险数据库中确定了 1900 名黑人患者和 15523 名非西班牙裔白人（NHW）患者，这些患者年龄在 65 岁或以上，被诊断患有食管鳞状细胞癌或食管腺癌。对患者进行随访，直至死亡或 2012 年 12 月 31 日。根据人口统计学（年龄、性别、诊断年份和 SEER 部位）、表现（人口统计学加癌症分期、分级和合并症）和治疗（表现变量加手术、化疗或放疗），将三组 1900 名 NHW 患者依次与同一组 1900 名黑人患者进行匹配。
在人口统计学匹配中，黑人患者（13.3%）和 NHW 患者（18.4%）的 5 年生存率绝对差异为 5.1%（95%CI，2.3%-7.7%；P=0.001）。在表现匹配后，5 年生存率的差异缩小到 2.3%（95%CI，0.3%-4.8%），但仍具有统计学意义（P=0.04）。进一步匹配与治疗相关因素的患者消除了 5 年生存率的种族差异（P=0.59）。在表现匹配的患者中，只有 10.8%的黑人患者接受了手术，而 NHW 患者为 22.8%（P<0.001）。组织学、肿瘤位置、社会经济状况、化疗和放疗均与手术的实施相关。然而，这些因素均无法解释手术接受率的种族差异。
在 SEER-医疗保险数据库中，手术治疗的使用不足可以解释黑人和 NHW 食管癌患者生存时间的差异。
