社会经济地位影响胰腺腺癌的生存及手术切除可及性：一项基于高分辨率人群的癌症登记研究
Socioeconomic status impacts survival and access to resection in pancreatic adenocarcinoma: A high-resolution population-based cancer registry study.
作者信息
Thobie Alexandre, Mulliri Andrea, Dolet Nathan, Eid Yassine, Bouvier Véronique, Launoy Guy, Alves Arnaud, Dejardin Olivier
机构信息
Department of Digestive Surgery, University Hospital of Caen, Caen cedex, France; UMR INSERM 1086 « ANTICIPE », University of Normandy, Caen, France; Department of Research, University Hospital of Caen, Caen cedex, France.
Department of Digestive Surgery, University Hospital of Caen, Caen cedex, France; Registre des tumeurs digestives du Calvados, France.
出版信息
Surg Oncol. 2018 Dec;27(4):759-766. doi: 10.1016/j.suronc.2018.10.008. Epub 2018 Oct 15.
BACKGROUND
Survival of patients with pancreatic adenocarcinoma (PA) is very poor. Resection status is highly associated with prognosis but only 15%-20% are resectable. The aim of this study was to analyse the impact of socioeconomic deprivation on PA survival and to define which management steps are affected.
METHODS
Between 01/01/2000 and 31/12/2014, 1451 incident cases of PA recorded in the digestive cancer registry of the French department of Calvados were included. The population was divided between less deprived areas (quintile 1) and more deprived areas (quintile 2,3,4,5 aggregated).
RESULTS
Patients from less deprived areas were younger at diagnosis than those from more deprived areas (69.9 vs 72.3 years, p = 0.01). There was no difference in stage or comorbidities. Three- and 5-year survival rates were significantly higher for less deprived areas than more deprived areas: 10.5% vs 5.15% and 4.7% vs 1.7% respectively (p = 0.01). In univariate analysis, those living in less deprived areas had a better survival than those in more deprived areas (HR = 0.81 [0.69-0.95], p = 0.009) but not in multivariable analysis (HRa = 0.93 [0.79-1.11], p = 0.383) or analysis stratified on resection. In multivariable regression, less deprived areas had more access to surgery than more deprived areas (ORa = 1.73 [1.08-2.47], p = 0.013). No difference was observed on access to adjuvant chemotherapy (ORa = 0.95 [0.38-2.34], p = 0.681).
CONCLUSION
The key to reducing survival inequalities in PA is access to resection, so future studies should investigate the factors impacting this issue.
背景
胰腺腺癌（PA）患者的生存率非常低。手术切除状态与预后高度相关，但只有15%-20%的患者可进行手术切除。本研究的目的是分析社会经济剥夺对PA患者生存的影响，并确定哪些治疗步骤受到影响。
方法
纳入2000年1月1日至2014年12月31日在法国卡尔瓦多斯省消化系统癌症登记处记录的1451例PA新发病例。将研究人群分为贫困程度较低地区（第一五分位数）和贫困程度较高地区（第二、三、四、五分位数合并）。
结果
贫困程度较低地区的患者诊断时年龄比贫困程度较高地区的患者年轻（69.9岁对72.3岁，p = 0.01）。分期或合并症方面无差异。贫困程度较低地区的3年和5年生存率显著高于贫困程度较高地区：分别为10.5%对5.15%和4.7%对1.7%（p = 0.01）。单因素分析中，生活在贫困程度较低地区的患者生存率高于贫困程度较高地区的患者（HR = 0.81[0.69 - 0.95]，p = 0.009），但多因素分析（HRa = 0.93[0.79 - 1.11]，p = 0.383）或按切除情况分层分析时并非如此。在多变量回归中，贫困程度较低地区比贫困程度较高地区有更多机会接受手术（ORa = 1.73[1.08 - 2.47]，p = 0.013）。在接受辅助化疗的机会方面未观察到差异（ORa = 0.95[0.38 - 2.34]，p = 0.681）。
结论
减少PA患者生存不平等的关键是获得手术切除的机会，因此未来的研究应调查影响这一问题的因素。
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