Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
Dis Esophagus. 2020 Mar 5;33(2). doi: 10.1093/dote/doz045.
The incidence of esophageal cancer has increased steadily in the last decades in the United States. The aim of this paper was to characterize disparities in esophageal cancer treatment in different racial and socioeconomic population groups and compare long-term survival among different treatment modalities. A retrospective analysis of the National Cancer Database was performed including adult patients (≥18 years old) with a diagnosis of resectable (stages I-III) esophageal cancer between 2004 and 2015. Multivariable logistic regression models were used to determine the odds of being offered no treatment at all and surgical treatment across race, primary insurance, travel distance, income, and education levels. Multivariable Cox proportional hazards models were used to compare 5-year survival rates across different treatment modalities. A total of 60,621 esophageal cancer patients were included. Black patients, uninsured patients, and patients living in areas with lower levels of education were more likely to be offered no treatment. Similarly, black race, female patients, nonprivately insured patients, and those living in areas with lower median residential income and lower education levels were associated with lower rates of surgery. Patients receiving surgical treatment, compared to both no treatment and definitive chemoradiation, had significant better long-term survival in stage I, II, and III esophageal cancer. In conclusion, underserved patients with esophageal cancer appear to have limited access to surgical care, and are, in fact, more likely to not be offered any treatment at all. Considering the survival benefits associated with surgical resection, greater public health efforts to reduce disparities in esophageal cancer are needed.
在过去几十年中，美国的食管癌发病率稳步上升。本文旨在描述不同种族和社会经济人群中食管癌治疗的差异，并比较不同治疗方式的长期生存情况。对国家癌症数据库进行了回顾性分析，纳入了 2004 年至 2015 年间诊断为可切除（I-III 期）食管癌的成年患者（≥18 岁）。多变量逻辑回归模型用于确定不同种族、主要保险、旅行距离、收入和教育水平的患者完全不接受治疗和接受手术治疗的可能性。多变量 Cox 比例风险模型用于比较不同治疗方式的 5 年生存率。共纳入 60621 例食管癌患者。黑人患者、无保险患者和居住在教育水平较低地区的患者更有可能不接受任何治疗。同样，黑人种族、女性患者、非私人保险患者以及居住在中位数收入和教育水平较低地区的患者接受手术治疗的比例较低。与完全不治疗和确定性放化疗相比，接受手术治疗的患者在 I 期、II 期和 III 期食管癌中的长期生存率显著提高。总之，服务不足的食管癌患者似乎获得手术治疗的机会有限，实际上更有可能完全不接受任何治疗。考虑到与手术切除相关的生存获益，需要加大公共卫生力度，减少食管癌的差异。
