Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
J Natl Cancer Inst. 2021 Jun 1;113(6):770-777. doi: 10.1093/jnci/djaa182.
The purpose of this study was to determine the association between race and long-term cancer outcomes (recurrence and overall survival) within a population of US patients with locoregional colorectal cancer (CRC).
A cohort study of primary patient data merged with the National Cancer Database as part of a Commission on Cancer Special Study was performed. The study population was a random sample of patients undergoing surgery for stage I to III CRC between years 2006 and 2007 with 5 years of follow-up. Propensity-weighted multivariable Cox regression was performed with pooled results to yield statistical inferences. Prespecified sensitivity analysis was performed only for patients who received guideline concordant care (GCC) of primary CRC. All statistical tests were 2-sided.
The study population included 8176 patients, 9.9% (n = 811) Black and 90.1% (n = 7365) White. Black patients were more likely to be uninsured or underinsured, have lower household income, and lower educational status (all P < .001). Rates of GCC were higher among Black vs White patients with colon cancer (76.9% vs 72.6%, P = .02), and Black and White patients with rectal cancer were treated with radiation at similar rates (69.1% vs 66.6%, P = .64). Black race was independently associated with increased risk of recurrence (hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.26 to 1.73) and mortality (HR = 1.37, 95% CI = 1.18 to 1.59). In sensitivity analysis of only patients who received GCC, observed effects for recurrence (HR = 1.51, 95% CI = 1.27 to 1.79) and overall survival (HR = 1.40, 95% CI = 1.18 to 1.66) persisted.
Despite higher rates of GCC for CRC, Black patients experience a higher risk of recurrence and mortality compared with White patients.
本研究旨在确定美国局部结直肠癌（CRC）患者人群中种族与长期癌症结局（复发和总体生存）之间的关联。
进行了一项主要患者数据与国家癌症数据库合并的队列研究，作为癌症委员会特别研究的一部分。研究人群为 2006 年至 2007 年间接受 I 至 III 期 CRC 手术且随访 5 年的随机患者样本。采用合并结果进行倾向加权多变量 Cox 回归，以得出统计学推论。仅对接受原发性 CRC 指南一致治疗（GCC）的患者进行了预设敏感性分析。所有统计检验均为双侧。
研究人群包括 8176 例患者，9.9%（n=811）为黑人，90.1%（n=7365）为白人。黑人患者更有可能没有保险或保险不足，家庭收入较低，教育程度较低（均 P<0.001）。结肠癌黑人患者的 GCC 率高于白人患者（76.9%比 72.6%，P=0.02），直肠癌黑人患者和白人患者接受放疗的比例相似（69.1%比 66.6%，P=0.64）。黑种人种族与复发风险增加独立相关（风险比[HR] = 1.48，95%置信区间[CI] = 1.26 至 1.73）和死亡率（HR = 1.37，95% CI = 1.18 至 1.59）。在仅接受 GCC 的患者的敏感性分析中，观察到复发（HR = 1.51，95% CI = 1.27 至 1.79）和总生存（HR = 1.40，95% CI = 1.18 至 1.66）的效应仍然存在。
尽管 CRC 的 GCC 率较高，但与白人患者相比，黑人患者的复发和死亡率风险更高。
