Ghaffarpasand Eiman, Welten Vanessa M, Fields Adam C, Lu Pamela W, Shabat Galyna, Zerhouni Yasmin, Farooq Ameer O, Melnitchouk Nelya
Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
J Surg Res. 2020 Dec;256:449-457. doi: 10.1016/j.jss.2020.07.008. Epub 2020 Aug 12.
There are various racial, socioeconomic, and tumor-specific factors that can impact rectal cancer outcomes. The current systematic review and meta-analysis evaluate the effect socioeconomic and racial variables on overall survival of rectal cancer patients after surgical resection.
A literature search was performed via electronic databases according to Systematic Reviews and Meta-Analyses and Meta-analysis Of Observational Studies in Epidemiology guidelines. All studies were evaluated by three authors and validated for data extraction. Predictive variables and survival profiles (1-, 5-, and 10-y survival and overall survival) reported by the studies were recorded for the systematic review. Hazard ratios, odds ratios, and 95% confidence intervals were extracted for meta-analysis. Forest plots were used to interpret the results. The primary outcome was the effect size of the predictive variables on overall survival after surgical resection.
Of the 265 articles collected, 22 met inclusion criteria. Sixteen studies were used for the systematic review, and 17 studies were considered for meta-analysis. Overall, 662,053 subjects with rectal cancer were studied (439,766 with race reported), of which 344,193 (78.3%) were White and 60,283 (13.7%) were Black. The median survival was 56.8% for White patients and 47.9% for Black patients. Meta-analysis revealed that race, socioeconomic variables (education level, income level, and insurance status), and facility characteristics (type and volume) were significantly associated with overall survival in rectal cancer.
Racial and socioeconomic disparities are present in outcomes for rectal cancer patients undergoing surgical resection. It is important to consider these disparities in the management of patients with rectal cancer to minimize any consequent disparities in surgical outcomes.
存在多种种族、社会经济和肿瘤特异性因素会影响直肠癌的治疗结果。当前的系统评价和荟萃分析评估了社会经济和种族变量对直肠癌患者手术切除后总生存期的影响。
根据系统评价和荟萃分析以及流行病学观察性研究的荟萃分析指南，通过电子数据库进行文献检索。所有研究均由三位作者进行评估，并对数据提取进行验证。记录研究报告的预测变量和生存情况（1年、5年和10年生存率以及总生存期）以进行系统评价。提取风险比、比值比和95%置信区间进行荟萃分析。采用森林图解释结果。主要结局是预测变量对手术切除后总生存期的效应大小。
在收集的265篇文章中，22篇符合纳入标准。16项研究用于系统评价，17项研究用于荟萃分析。总体而言，共研究了662,053例直肠癌患者（其中439,766例报告了种族），其中344,193例（78.3%）为白人，60,283例（13.7%）为黑人。白人患者的中位生存期为56.8%，黑人患者为47.9%。荟萃分析显示，种族、社会经济变量（教育水平、收入水平和保险状况）以及机构特征（类型和规模）与直肠癌的总生存期显著相关。
接受手术切除的直肠癌患者的治疗结果存在种族和社会经济差异。在直肠癌患者的管理中考虑这些差异很重要，以尽量减少手术结果方面随之而来的任何差异。
