Hispanics 食管癌患者的种族差异、结局和手术利用：监测、流行病学和最终结果计划数据库分析。

Racial Disparities, Outcomes, and Surgical Utilization among Hispanics with Esophageal Cancer: A Surveillance, Epidemiology, and End Results Program Database Analysis.

机构信息

Department of Internal Medicine, Emory University, Atlanta, Georgia, USA.

Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.

出版信息

Oncology. 2019;97(1):49-58. doi: 10.1159/000499716. Epub 2019 May 20.

DOI:10.1159/000499716

PMID:31108497

Abstract

BACKGROUND

Hispanic patients with esophageal cancer (EC) have racially disparate survival outcomes compared with white patients.

OBJECTIVES

We explored the impact on survival of racial differences in socioeconomic factors, tumor characteristics, and rates of surgical utilization in patients with EC.

METHOD

Using the SEER (Surveillance, Epidemiology, and End Results) registry, we identified 22,531 cases of EC in Hispanic and white patients between the ages of 18 and 65 years in 2003-2014. Of these, 6,250 cases had locoregional EC. Patients were categorized according to age, gender, education, tumor grade, histology, primary tumor site, and surgical status. Postdiagnosis survival was examined over time and compared by race and stratified by surgical status.

RESULTS

Compared with whites, Hispanics with EC had significantly higher unadjusted mortality (hazard ratio [HR] 1.11; 95% confidence interval [CI] 1.06-1.17; p < 0.001) as did Hispanics with locoregional EC (HR 1.15; 95% CI 1.03-1.29; p = 0.01). In the multivariate analysis, several socioeconomic and tumor factors were found to be independently associated with survival by race, including county of residence income and prevalence of smoking, tumor grade, stage, and primary site, and surgical utilization. After adjusting for demographic and tumor characteristics, surgical utilization in patients with locoregional EC had a significant interaction with race on overall mortality (p = 0.01). Hispanics with locoregional EC were significantly less likely to receive surgery than whites (46 vs. 60%; p < 0.001) and not receiving surgery was associated with a significantly lower overall survival (HR 2.84; 95% CI 2.65-3.04; p < 0.001).

CONCLUSIONS

A lower rate of surgery among Hispanics with potentially resectable esophageal cancer was associated with a decreased survival rate when compared to whites, even when adjusting for relevant socioeconomic and tumor factors. These data support the need to better address patient barriers to surgical treatment and the systemic biases present in medical care.

摘要

背景

与白人患者相比，西班牙裔食管癌（EC）患者的生存结果存在明显的种族差异。

目的

我们探讨了 EC 患者在社会经济因素、肿瘤特征以及手术利用率方面的种族差异对生存的影响。

方法

我们使用 SEER（监测、流行病学和最终结果）登记处，在 2003 年至 2014 年间，确定了年龄在 18 至 65 岁之间的西班牙裔和白人患者中的 22531 例 EC 病例。其中，6250 例为局部区域 EC。根据年龄、性别、教育程度、肿瘤分级、组织学、原发肿瘤部位和手术状态对患者进行分类。检查了诊断后随时间的生存情况，并按种族进行比较，并按手术状态分层。

结果

与白人患者相比，EC 西班牙裔患者的死亡率明显更高（风险比 [HR] 1.11；95%置信区间 [CI] 1.06-1.17；p < 0.001），局部区域 EC 西班牙裔患者也是如此（HR 1.15；95%CI 1.03-1.29；p = 0.01）。在多变量分析中，发现包括居住县收入和吸烟流行率、肿瘤分级、分期和原发部位以及手术利用在内的几个社会经济和肿瘤因素与种族相关的生存情况独立相关。在调整了人口统计学和肿瘤特征后，局部区域 EC 患者的手术利用与种族之间的总体死亡率存在显著交互作用（p = 0.01）。与白人患者相比，局部区域 EC 的西班牙裔患者接受手术的可能性明显较低（46%比 60%；p < 0.001），并且不接受手术与总体生存率显著降低相关（HR 2.84；95%CI 2.65-3.04；p < 0.001）。