Department of Surgery, University of Alabama at Birmingham, Birmingham, USA.
Department of Surgery, University of Alabama at Birmingham, Birmingham, USA.
Am J Surg. 2019 Apr;217(4):725-731. doi: 10.1016/j.amjsurg.2018.12.007. Epub 2018 Dec 10.
The aim of this study was to evaluate health disparities in the outcomes of patients with resectable pancreatic adenocarcinoma.
We retrospectively analyzed 280,935 patients from the National Cancer Data Base (NCDB), from 1998 to 2012 to compare the differences in patient characteristics, refusal of offered surgical treatment and overall survival after pancreatic adenocarcinoma resection between white vs. black patients.
Black patients did not undergo and refused offered surgical treatment more frequently. Race and insurance were the most important factors independently associated with not receiving the offered resection. Having private insurance, Hispanic ethnic background, geographic location, higher income, residing in urban/metropolitan area and systemic treatment were independently associated with improved survival. Race was associated with overall worse survival in an unadjusted model but not in multivariable analysis. The association between race and survival was removed when adjusting for facility location, income, education, tumor size, tumor stage or systemic treatment.
Disparities exist at various levels in resectable pancreatic cancers. These findings help developing targeted interventions and quality improvement initiatives.
本研究旨在评估可切除胰腺腺癌患者结局的健康差异。
我们回顾性分析了 1998 年至 2012 年国家癌症数据库（NCDB）中的 280935 例患者，比较白种人与黑种人患者的特征差异、拒绝接受推荐手术治疗的情况以及胰腺腺癌切除术后的总生存率。
黑种人患者接受和拒绝推荐手术治疗的频率均较低。种族和保险是与未接受推荐切除术最相关的重要因素。拥有私人保险、西班牙裔背景、地理位置、高收入、居住在城市/都会区以及全身治疗与生存改善相关。在未调整模型中，种族与总生存率相关，但在多变量分析中则不相关。当调整设施位置、收入、教育、肿瘤大小、肿瘤分期或全身治疗时，种族与生存之间的关联消失。
在可切除胰腺癌的各个层面都存在差异。这些发现有助于制定有针对性的干预措施和质量改进计划。
