Ren Fenggang, Zhang Jing, Gao Zhongyang, Zhu Haoyang, Chen Xue, Liu Wenyan, Xue Zhao, Gao Weiman, Wu Rongqian, Lv Yi, Hu Liangshuo
Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.
Regenerative Medicine and Surgery Engineering Research Center of Shaanxi Province, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.
Oncol Lett. 2018 Dec;16(6):7102-7116. doi: 10.3892/ol.2018.9550. Epub 2018 Oct 5.
The aim of the present study was to investigate the racial disparities in the presentation, treatment and survival time of patients with hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC) between Chinese and other racial groups from the Surveillance, Epidemiology, and End Results (SEER) database between January 1st 2004, and December 31st 2013. Key covariates, including clinical presentation, treatment and survival time, were recorded and compared, demonstrating the racial differences. Kaplan-Meier analysis and Cox regression models were performed to identify these disparities in survival time. A total of 30,954 patients were identified in the SEER database. Among these, 27,767 (89.7%) had HCC and 3,187 (10.3%) had ICC. In the HCC cohort, Chinese patients had the highest survival time. Compared with the mortality risk of Chinese patients, the mortality risk of Other Asian, non-Hispanic white, Hispanic and African-American patients increased by 16.8, 35.1, 28.3 and 33.3%, respectively. Compared with other groups, Chinese patients were more likely to present with localized stage, and without vascular invasion, adjacent invasion and metastasis. In the ICC cohort, the Chinese group had improved survival time, compared with the other groups following univariate analysis, although no significant differences were observed between Chinese and Other Asian and Hispanic patients following adjusting for contributing factors. Furthermore, there was no significant differences in the presentation between the groups, which differed from the HCC analysis. In conclusion, race/ethnicity was a significant independent prognostic factor in the HCC cohort, whereas it was not significant in the ICC cohort. The synergistic effect of contributing factors, including demographic, socioeconomic, biological and treatment differences, caused the racial disparity observed in primary liver cancer survival time.
本研究旨在调查2004年1月1日至2013年12月31日期间，来自监测、流行病学和最终结果（SEER）数据库的中国与其他种族群体的肝细胞癌（HCC）或肝内胆管癌（ICC）患者在临床表现、治疗及生存时间方面的种族差异。记录并比较了包括临床表现、治疗及生存时间在内的关键协变量，以揭示种族差异。采用Kaplan-Meier分析和Cox回归模型来确定生存时间的这些差异。在SEER数据库中总共识别出30954例患者。其中，27767例（89.7%）患有HCC，3187例（10.3%）患有ICC。在HCC队列中，中国患者的生存时间最长。与中国患者的死亡风险相比，其他亚洲、非西班牙裔白人、西班牙裔和非裔美国患者的死亡风险分别增加了16.8%、35.1%、28.3%和33.3%。与其他组相比，中国患者更易表现为局部阶段，且无血管侵犯、邻近侵犯和转移。在ICC队列中，单因素分析后中国组的生存时间有所改善，尽管在调整影响因素后，中国患者与其他亚洲和西班牙裔患者之间未观察到显著差异。此外，各组之间在临床表现上无显著差异，这与HCC分析不同。总之，种族/民族是HCC队列中的一个显著独立预后因素，而在ICC队列中并不显著。包括人口统计学、社会经济、生物学和治疗差异在内的影响因素的协同作用导致了原发性肝癌生存时间中观察到的种族差异。
