田纳西州小儿肾肿瘤患者的健康差异。

Health disparities among tennessee pediatric renal tumor patients.

作者信息

Neuzil Kevin, Apple Annie, Sybenga Amelia, Chen Heidi, Zhao Shilin, Whiteside Martin, Correa Hernan, Phelps Hannah M, Lovvorn Harold N

机构信息

School of Medicine, Vanderbilt University Medical Center, 1611 21(st) Avenue South, Nashville, TN; Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN.

出版信息

J Pediatr Surg. 2020 Jun;55(6):1081-1087. doi: 10.1016/j.jpedsurg.2020.02.029. Epub 2020 Feb 28.

DOI:10.1016/j.jpedsurg.2020.02.029

PMID:32173121

Abstract

BACKGROUND/PURPOSE: Wilms tumor (WT) poses a cancer health disparity to black children globally, which has not been evaluated thoroughly for other pediatric renal cancers. We aimed to characterize health disparities among Tennessee children treated for any renal cancer.

METHODS

The Tennessee Cancer Registry (TCR) was queried for patients ≤18 years having any renal cancer (n = 160). To clarify treatment and outcomes, we performed a retrospective cohort study of pediatric renal cancer patients in our institutional cancer registry (ICR; n = 121). Diagnoses in both registries included WT, Sarcoma/Other, and Renal Cell Carcinoma. Wilcoxon/Pearson, Kaplan-Meier, and logistic regression were completed.

RESULTS

In both registries, WT comprised the most common renal cancer and youngest median age. Sarcoma was intermediate in frequency and age, and RCC was least common, having the oldest age (p < 0.001). In the TCR, black patients comprised 26% of all patients, presented more commonly with distant disease than white patients (37% v. 16%; p = 0.021), and showed worse overall survival (73% v. 89%; p = 0.018), while the ICR showed similar survival between race groups (92% v. 93%, p = 0.868). Sarcoma and metastases were independent predictors of death in both registries (p ≤ 0.002).

CONCLUSIONS

Black children in Tennessee presented with more advanced disease and experienced worse survival when combining all renal cancer types, particularly RCC and Sarcoma. When treated at a comprehensive pediatric cancer center, these survival disparities appear diminished.

TYPE OF STUDY

Prognostic study.

LEVEL OF EVIDENCE

Level II (retrospective cohort).

摘要

背景/目的：肾母细胞瘤（WT）在全球范围内给黑人儿童带来了癌症健康差异，而其他小儿肾癌尚未对此进行全面评估。我们旨在描述田纳西州接受任何肾癌治疗的儿童的健康差异。

方法

查询田纳西州癌症登记处（TCR）中年龄≤18岁的任何肾癌患者（n = 160）。为了阐明治疗情况和结果，我们对机构癌症登记处（ICR；n = 121）中的小儿肾癌患者进行了一项回顾性队列研究。两个登记处的诊断包括WT、肉瘤/其他以及肾细胞癌。完成了Wilcoxon/ Pearson检验、Kaplan-Meier分析和逻辑回归分析。

结果

在两个登记处中，WT都是最常见的肾癌类型，且中位年龄最小。肉瘤的发病率和年龄处于中间水平，肾细胞癌最不常见，年龄最大（p < 0.001）。在TCR中，黑人患者占所有患者的26%，与白人患者相比，远处疾病的发生率更高（37%对16%；p = 0.021），总体生存率更低（73%对89%；p = 0.018），而ICR显示不同种族组之间的生存率相似（92%对93%，p = 0.868）。肉瘤和转移是两个登记处死亡的独立预测因素（p≤0.002）。