Mahase Sean, Christos Paul, Wang Xin, Potters Louis, Wernicke A Gabriella, Parashar Bhupesh
Radiation Oncology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, USA.
Biostatistics and Epidemiology, New York-Presbyterian/Weill Cornell Medical Center, New York, USA.
Cureus. 2018 Nov 12;10(11):e3575. doi: 10.7759/cureus.3575.
Purpose This study evaluates regional poverty level-dependent differences in lung cancer (LC) survival, focusing on patients receiving radiation therapy (RT). Methods and materials The Surveillance, Epidemiology, and End Results (SEER) database was used to retrospectively identify patients diagnosed with LC between 2000 and 2009. Patients were divided into socioeconomic status (SES) quintiles, with quintiles 1 and 5 representing the highest and lowest SES cohorts, respectively. The Kaplan-Meier method with the log-rank test was used to compare overall survival (OS) from diagnosis between demographic and clinical factor levels. Multivariate (MVA) Cox proportional hazards regression was used to examine the association of quintile and mortality, adjusting for demographic and clinical factors. Results Compared to those not receiving RT, the univariate (UVA) results showed a higher mortality associated with receiving RT (HR:1.091; CI:1.081-1.102) while the MVA demonstrated a protective effect (HR:0.882; CI:0.873-0.891). The MVA revealed that men had higher mortality rates than women (HR:1.192; CI:1.180-1.203). Caucasians had a lower mortality rate as compared to African Americans (adjusted HR:0.932; CI:0.918-0.947) while Asians, Pacific Islanders, and Native Americans had the highest overall survival rates (adjusted HR:0.752, CI:0.734-0.771). Among the entire study population, quintile 2 (HR:1.059, CI:1.043-1.076), quintile 3 (HR:1.091, CI:1.075-1.108), quintile 4 (HR:1.094, CI:1079-1.110), and quintile 5 (HR:1.201, CI:1.181-1.221) reported increased mortality rates compared with quintile 1. This trend was also observed among those undergoing RT, with quintile 2 (HR:1.034, CI:1.010-1.059), quintile 3 (HR:1.045; CI:1.021-1.069), quintile 4 (HR:1.056; CI:1.033-1.080), and quintile 5 (HR:1.153; CI:1.124-1.183) demonstrating incrementally worse OS. Conclusions Upon accounting for age, gender, race, SES, and tumor stage, RT may provide a positive survival benefit among those who received treatment. Minimal differences existed among SES quintiles regarding diagnoses made by tumor stage or patients receiving RT. An incrementally worse OS rate was associated with increasing regional poverty level. This trend persevered among those receiving RT.
目的 本研究评估肺癌（LC）生存率在区域贫困水平上的差异，重点关注接受放射治疗（RT）的患者。方法和材料 使用监测、流行病学和最终结果（SEER）数据库回顾性识别2000年至2009年间诊断为LC的患者。患者被分为社会经济地位（SES）五分位数，五分位数1和5分别代表最高和最低SES队列。采用Kaplan-Meier方法和对数秩检验比较不同人口统计学和临床因素水平下从诊断开始的总生存期（OS）。多变量（MVA）Cox比例风险回归用于检验五分位数与死亡率的关联，并对人口统计学和临床因素进行调整。结果 与未接受RT的患者相比，单变量（UVA）结果显示接受RT与更高的死亡率相关（HR：1.091；CI：1.081 - 1.102），而MVA显示出保护作用（HR：0.882；CI：0.873 - 0.891）。MVA显示男性死亡率高于女性（HR：1.192；CI：1.180 - 1.203）。与非裔美国人相比，白种人的死亡率较低（调整后HR：0.932；CI：0.918 - 0.947），而亚洲人、太平洋岛民和美洲原住民的总生存率最高（调整后HR：0.752，CI：0.734 - 0.771）。在整个研究人群中，与五分位数1相比，五分位数2（HR：1.059，CI：1.043 - 1.076）、五分位数3（HR：1.091，CI：1.075 - 1.108）、五分位数4（HR：1.094，CI：1.079 - 1.110）和五分位数5（HR：1.201，CI：1.181 - 1.221）报告的死亡率增加。在接受RT的患者中也观察到了这种趋势，五分位数2（HR：1.034，CI：1.010 - 1.059）、五分位数3（HR：1.045；CI：1.021 - 1.069）、五分位数4（HR：1.056；CI：1.033 - 1.080）和五分位数5（HR：1.153；CI：1.124 - 1.183）的OS逐渐变差。结论 在考虑年龄、性别、种族、SES和肿瘤分期后，RT可能为接受治疗的患者提供积极的生存益处。在肿瘤分期诊断或接受RT的患者中，SES五分位数之间存在最小差异。OS率逐渐变差与区域贫困水平增加相关。这种趋势在接受RT的患者中持续存在。
