种族和社会人口因素对胃癌切除术减少的影响：一项全国性研究。
Influence of race and sociodemographic factors on declining resection for gastric cancer: A national study.
机构信息
Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore - C500, Boston, MA, 02118, USA; University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA, 01655, USA.
Department of Surgery, Boston Medical Center, Boston University, 88 East Newton Street Collamore - C500, Boston, MA, 02118, USA.
出版信息
Am J Surg. 2021 Jan;221(1):155-161. doi: 10.1016/j.amjsurg.2020.06.022. Epub 2020 Jul 7.
BACKGROUND
The purpose of this study was to determine whether racial or other demographic characteristics were associated with declining surgery for early stage gastric cancer.
METHODS
Patients with clinical stage I-II gastric adenocarcinoma were identified from the NCDB. Multivariable logistic models identified predictors for declining resection. Patients were stratified based on propensity scores, which were modeled on the probability of declining. Overall survival was evaluated using the Kaplan-Meier method.
RESULTS
Of 11,326 patients, 3.68% (n = 417) declined resection. Patients were more likely to refuse if they were black (p < 0.001), had Medicaid or no insurance (p < 0.001), had shorter travel distance to the hospital (p < 0.001) or were treated at a non-academic center (p = 0.001). After stratification, patients who declined surgery had worse overall survival (all strata, p < 0.001).
CONCLUSIONS
Racial and sociodemographic disparities exist in the treatment of potentially curable gastric cancer, with patients who decline recommended surgery suffering worse overall survival.
背景
本研究旨在确定种族或其他人口统计学特征是否与早期胃癌手术治疗的减少有关。
方法
从 NCDB 中确定临床分期 I-II 期胃腺癌患者。多变量逻辑模型确定了拒绝切除的预测因素。根据倾向评分对患者进行分层，该评分是基于拒绝的概率来建模的。使用 Kaplan-Meier 方法评估总生存率。
结果
在 11326 名患者中，有 3.68%（n=417）拒绝了切除。如果患者是黑人（p<0.001）、拥有医疗补助或没有保险（p<0.001）、前往医院的旅行距离较短（p<0.001）或在非学术中心接受治疗（p=0.001），则更有可能拒绝手术。分层后，拒绝手术的患者总生存率更差（所有分层，p<0.001）。
结论
在可治愈的胃癌治疗中存在种族和社会人口统计学差异，拒绝推荐手术的患者总生存率更差。
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