1 Department of Preventive Medicine and Community Health, University of Texas Medical Branch , Galveston, Texas.
2 Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center , Houston, Texas.
J Adolesc Young Adult Oncol. 2018 Dec;7(6):681-687. doi: 10.1089/jayao.2018.0034. Epub 2018 Aug 10.
Examine disparities in survival for adolescents and young adults (AYAs) diagnosed with bone and soft tissue sarcomas in Texas compared with national estimates.
AYAs with sarcomas diagnosed between 1995 and 2012 at ages 15-39 years were identified from the Texas Cancer Registry (TCR) and Surveillance, Epidemiology, and End Results (SEER) program. Patient demographic, treatment, and clinical characteristics were compared between TCR and SEER using chi-squared tests. Five-year survival was computed using the Kaplan-Meier method. Cox proportional hazards (CPH) models evaluated the factors associated with the risk of mortality between and within the two datasets.
Sarcoma patients in TCR were more likely to be Hispanic, uninsured, diagnosed at late stage, and have lower rates of surgery as the first line of treatment than those in SEER. In Texas, 5-year survival was 68.7% versus 72.2% in SEER (p < 0.001). However, after including surgery in our fully adjusted CPH model, survival differences between the two datasets were no longer observed. In these models, males, and those living in nonmetropolitan areas were more likely to die than their counterparts in both datasets. In TCR, those who lived in the U.S. and Mexico border had higher mortality. In SEER, Hispanics and non-Hispanic blacks had higher mortality.
The adjusted AYA sarcoma survival in Texas was similar to that of SEER, but patients in Texas were more likely to be uninsured and have lower surgery rates. Those living in the U.S. and Mexico border in Texas faced lower survival. These results are important for delineating effective care for this high-risk patient group.
与全国估计数相比，检查德克萨斯州青少年和年轻成人（AYA）诊断为骨和软组织肉瘤的生存率差异。
从德克萨斯癌症登记处（TCR）和监测、流行病学和最终结果（SEER）计划中确定了 1995 年至 2012 年间年龄在 15-39 岁之间诊断为肉瘤的 AYA。使用卡方检验比较 TCR 和 SEER 之间的患者人口统计学、治疗和临床特征。使用 Kaplan-Meier 方法计算五年生存率。Cox 比例风险（CPH）模型评估了两个数据集之间和内部与死亡率相关的因素。
TCR 中的肉瘤患者比 SEER 更有可能是西班牙裔、没有保险、诊断为晚期，并且一线治疗的手术率较低。在德克萨斯州，5 年生存率为 68.7%，而 SEER 为 72.2%（p<0.001）。然而，在我们的完全调整的 CPH 模型中纳入手术后，两个数据集之间的生存差异不再观察到。在这些模型中，男性和居住在非城市地区的人比两个数据集的同龄人更有可能死亡。在 TCR 中，居住在美国和墨西哥边境的人死亡率更高。在 SEER 中，西班牙裔和非西班牙裔黑人的死亡率更高。
德克萨斯州调整后的 AYA 肉瘤生存率与 SEER 相似，但德克萨斯州的患者更有可能没有保险，并且手术率较低。居住在美国和墨西哥边境的德克萨斯州人面临更低的生存率。这些结果对于确定这一高风险患者群体的有效护理非常重要。
