Division of Hematology and Oncology.
Department of Internal Medicine, Capital Health Regional Medical Center, NJ.
Am J Clin Oncol. 2020 Nov;43(11):762-769. doi: 10.1097/COC.0000000000000744.
Although cure rates for early stage anal squamous cell cancer (ASCC) are overall high, there may be racial disparities in receipt of treatment and outcome precluding favorable outcomes across all patient demographics. Therefore, the authors aimed to assess the time to treatment initiation and overall survival (OS) in Black and White patients receiving definitive chemoradiation for early stage ASCC.
The authors identified patients diagnosed with early stage (stage I-II) ASCC and treated with chemoradiation diagnosed between 2004 and 2016 in the National Cancer Database. Clinical and treatment variables were compared by race using the χ test, and OS assessed through Cox regression with 1:1 nearest neighbor propensity score matching.
Among 9331 patients, 90.6% were White. Black patients had longer median time to treatment initiation as compared with White patients (47 vs. 36 d, P<0.001), and on multivariable analysis, the Black race was associated with higher odds of >6 weeks of time to treatment initiation (hazard ratio, 1.78; 95% confidence interval, 1.53-2.08; P<0.001). Furthermore, Black patients had worse OS (5-year survival 71% vs. 77%; P<0.001), which persisted after propensity score matching (P=0.007).
Black patients had a longer time to treatment initiation and worse OS as compared with White patients with early stage ASCC treated with chemoradiation. Further research is needed to better elucidate the etiologies of these disparities.
尽管早期肛门鳞状细胞癌（ASCC）的治愈率总体较高，但在接受治疗和结局方面可能存在种族差异，从而使所有患者人群都无法获得良好的结局。因此，作者旨在评估接受根治性放化疗的早期 ASCC 黑人和白人患者的治疗开始时间和总生存期（OS）。
作者在国家癌症数据库中确定了 2004 年至 2016 年间诊断为早期（I-II 期）ASCC 并接受放化疗的患者。使用 χ 检验比较种族间的临床和治疗变量，并通过 1:1 最近邻倾向评分匹配的 Cox 回归评估 OS。
在 9331 例患者中，90.6%为白人。与白人患者相比，黑人患者的治疗开始时间中位数更长（47 天 vs. 36 天，P<0.001），多变量分析显示，黑人种族与治疗开始时间超过 6 周的几率更高相关（风险比，1.78；95%置信区间，1.53-2.08；P<0.001）。此外，黑人患者的 OS 更差（5 年生存率 71% vs. 77%；P<0.001），在倾向评分匹配后仍然存在（P=0.007）。
与接受放化疗的早期 ASCC 白人群体相比，黑人患者的治疗开始时间更长，OS 更差。需要进一步研究以更好地阐明这些差异的病因。
