Faculty of Health, Queensland University of Technology, Brisbane, Australia.
Cancer Council Queensland, Brisbane, Australia.
Cancer Epidemiol Biomarkers Prev. 2019 Sep;28(9):1427-1434. doi: 10.1158/1055-9965.EPI-19-0203. Epub 2019 Jun 25.
China contributes to almost half of the esophageal cancer cases diagnosed globally each year. However, the prognosis information of this disease in this large population is scarce.
Data on a population-based cohort consisting of residents of Shandong Province, China who were diagnosed with esophageal cancer during the period from 2005 to 2014 were analyzed. The cancer-specific survival rates were estimated using Kaplan-Meier analysis. Discrete-time multilevel mixed-effects survival models were used to investigate socioeconomic status (SES) disparities on esophageal cancer survival.
The unadjusted 1-, 3-, and 5-year cause-specific survival rates were 59.6% [95% confidence interval (CI), 59.2%-59.9%], 31.9% (95% CI, 31.5%-32.3%), and 23.6% (95% CI, 23.1%-24.0%), respectively. Patients of blue-collar occupations had higher risk of esophageal cancer-related death than those of white-collar occupations in the first 2 years after diagnosis. Rural patients had higher risk of death than urban patients in the first 3 years after diagnosis. The risks of esophageal cancer-related death among patients living in low/middle/high SES index counties were not different in the first 2 years after diagnosis. However, patients living in high SES index counties had better long-term survival (3-5 years postdiagnosis) than those living in middle or low SES index counties.
Socioeconomic inequalities in esophageal cancer survival exist in this Chinese population. Higher individual- or area-level SES is associated with better short-term or long-term cancer survival.
Elucidation of the relative roles of the SES factors on survival could guide interventions to reduce disparities in the prognosis of esophageal cancer.
中国每年诊断出的食管癌病例几乎占全球的一半。然而，在这个庞大的人群中，这种疾病的预后信息却很缺乏。
对 2005 年至 2014 年间在中国山东省被诊断为食管癌的居民进行了一项基于人群的队列研究。采用 Kaplan-Meier 分析估计癌症特异性生存率。采用离散时间多水平混合效应生存模型研究社会经济地位（SES）对食管癌生存的差异。
未经调整的 1、3 和 5 年癌症特异性生存率分别为 59.6%（95%置信区间[CI]，59.2%-59.9%）、31.9%（95% CI，31.5%-32.3%）和 23.6%（95% CI，23.1%-24.0%）。与白领职业相比，蓝领职业的患者在诊断后 2 年内死于食管癌的风险更高。农村患者在诊断后 3 年内的死亡风险高于城市患者。在诊断后 2 年内，居住在低/中/高 SES 指数县的患者的食管癌相关死亡风险没有差异。然而，居住在高 SES 指数县的患者的长期生存（诊断后 3-5 年）要好于居住在中低 SES 指数县的患者。
在这个中国人群中，食管癌生存存在社会经济不平等现象。较高的个体或地区 SES 水平与短期或长期癌症生存较好相关。
阐明 SES 因素对生存的相对作用，可以指导干预措施，减少食管癌预后的差异。
