Harvard Medical School, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA.
Am J Surg. 2021 Jan;221(1):39-45. doi: 10.1016/j.amjsurg.2020.06.020. Epub 2020 Jun 23.
We aimed to identify factors associated with refusal of surgery among patients with colon cancer.
This 2004-2016 NCDB retrospective study identified AJCC stage I-III colon cancer patients who were recommended surgery. Multivariable logistic regression defined adjusted odds ratios of refusing treatment, with sociodemographic and clinical covariates. Treatment propensity-adjusted Cox proportional hazard ratios defined differential survival stratified by clinical stage, controlling for potential confounders.
Of 170,594 patients recommended surgery, 1116 refused. Increased rates of surgery refusal were associated with older age, African American race, CDCC>3, and female sex. Decreased rates of surgery refusal were associated with higher income and private insurance. Stratifying by stage, refusal rates among African Americans remained disparately high. Refusal of surgery was associated with worse overall survival.
Disparate rates of refusal of surgery for resectable colon cancer by race and other sociodemographic factors highlight potential treatment adherence reinforcement beneficiaries, necessitating further study of shared decision-making.
我们旨在确定与结肠癌患者拒绝手术相关的因素。
这项 2004-2016 年 NCDB 的回顾性研究确定了被建议接受手术的 AJCC 分期 I-III 期结肠癌患者。多变量逻辑回归定义了拒绝治疗的调整比值比，同时考虑了社会人口统计学和临床因素。在控制潜在混杂因素的情况下，根据临床分期分层，采用治疗倾向性调整的 Cox 比例风险比定义了不同的生存情况。
在被建议接受手术的 170594 名患者中，有 1116 人拒绝了手术。手术拒绝率的增加与年龄较大、非裔美国人、CDCC>3 和女性有关。手术拒绝率的降低与较高的收入和私人保险有关。按分期分层，非裔美国人的拒绝率仍然存在明显差异。拒绝手术与总体生存率较差有关。
按种族和其他社会人口统计学因素划分的可切除结肠癌手术拒绝率存在差异，这突出了潜在的治疗依从性强化受益者，需要进一步研究共同决策。
