Department of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.
JNCI Cancer Spectr. 2020 Nov 2;5(1). doi: 10.1093/jncics/pkaa100. eCollection 2021 Feb.
Hepatocellular carcinoma is 1 of few cancers with rising incidence and mortality in the United States. Little is known about disease presentation and outcomes across the rural-urban continuum.
Using the population-based Surveillance, Epidemiology, and End Results registry, we identified adults with incident hepatocellular carcinoma between 2000 and 2016. Urban, suburban, and rural residence at time of cancer diagnosis were categorized by the Census Bureau's percent of the population living in nonurban areas. We examined association between place of residence and overall survival. Secondary outcomes were late tumor stage and receipt of therapy.
Of 83 368 incident cases of hepatocellular carcinoma, 75.8%, 20.4%, and 3.8% lived in urban, suburban, and rural communities, respectively. Median survival was 7 months (interquartile range = 2-24). All stage and stage-specific survival differed by place of residence, except for distant stage. In adjusted models, rural and suburban residents had a respective 1.09-fold (95% confidence interval [CI] = 1.04 to 1.14; < .001) and 1.08-fold (95% CI = 1.05 to 1.10; < .001) increased hazard of overall mortality as compared with urban residents. Furthermore, rural and suburban residents had 18% (odds ratio [OR] = 1.18, 95% CI = 1.10 to 1.27; < .001) and 5% (OR = 1.05, 95% CI = 1.02 to 1.09; = .003) higher odds of diagnosis at late stage and were 12% (OR = 0.88, 95% CI = 0.80 to 0.94; < .001) and 8% (OR = 0.92, 95% CI = 0.88 to 0.95; < .001) less likely to receive treatment, respectively, compared with urban residents.
Residence in a suburban and rural community at time of diagnosis was independently associated with worse indicators across the cancer continuum for liver cancer. Further research is needed to elucidate the primary drivers of these rural-urban disparities.
肝细胞癌是美国少数几种发病率和死亡率呈上升趋势的癌症之一。人们对农村到城市连续体中疾病表现和结果知之甚少。
利用基于人群的监测、流行病学和最终结果登记处，我们确定了 2000 年至 2016 年间患有肝细胞癌的成年人。癌症诊断时的城市、郊区和农村居住情况按人口普查局非城市地区人口的百分比进行分类。我们检查了居住地与总生存率之间的关联。次要结果是晚期肿瘤分期和接受治疗的情况。
在 83368 例肝细胞癌的发病病例中，分别有 75.8%、20.4%和 3.8%居住在城市、郊区和农村社区。中位生存期为 7 个月（四分位间距=2-24）。除远处分期外，所有分期和各分期的生存率均因居住地而异。在调整后的模型中，农村和郊区居民的总体死亡率分别增加了 0.99 倍（95%置信区间[CI]为 1.04 至 1.14； < .001）和 0.98 倍（95%CI=1.05 至 1.10； < .001），而与城市居民相比。此外，农村和郊区居民的晚期诊断的几率分别增加了 18%（比值比[OR] = 1.18，95%CI = 1.10 至 1.27； < .001）和 5%（OR = 1.05，95%CI = 1.02 至 1.09； = .003），而接受治疗的几率分别降低了 12%（OR = 0.88，95%CI = 0.80 至 0.94； < .001）和 8%（OR = 0.92，95%CI = 0.88 至 0.95； < .001），与城市居民相比。
诊断时居住在郊区和农村社区与肝癌整个癌症连续体中的预后较差指标独立相关。需要进一步研究以阐明这些城乡差距的主要驱动因素。
