Clinical Medical College, Southwest Medical University, Luzhou, China.
Department of Gastroenterology and Hepatology, Huaihe Hospital of Henan University, Kaifeng, China.
Cancer Med. 2023 Feb;12(3):3509-3519. doi: 10.1002/cam4.5141. Epub 2022 Aug 15.
The American Society of Clinical Oncology (ASCO) has strived to address racial/ethnic disparities in cancer care since 2009. Surgery plays a pivotal role in cancer care; however, it is unclear whether and how racial/ethnic disparities in cancer surgery have changed over time.
This cohort study included 1,113,256 White and Black cancer patients across 9 years (2007-2015) using patient data extracted from the Surveillance, Epidemiology, and End Results (SEER)-18 registries. Patient data were included from 2007 to adjust insurance status and by 2015 to obtain at least a 3-year survival follow-up (until 2018). The primary outcome was a surgical intervention. The secondary outcomes were the use of (neo)adjuvant chemotherapy and cancer-specific survival (CSS). Adjusted associations of the race (Black/White) with the outcomes were measured in each cancer type and year.
The gap between surgery rates for Black and White patients narrowed overall, from an adjusted odds ratio (aOR) of 0.621 (0.592-0.652) in 2007 to 0.734 (0.702-0.768) in 2015. However, the racial gap persisted in the surgery rates for lung, breast, prostate, esophageal, and ovarian cancers. In surgically treated patients with lymph node metastasis, Black patients with colorectal cancer (CRC) were less likely to receive (neo)adjuvant chemotherapy than White patients. Black patients undergoing surgery were more likely to have a worse CSS rate than White patients undergoing surgery. In breast cancer patients, the overall trend was narrow, but continuously present, with an adjusted hazard ratio (aHR) of 1.224 (1.278-1.173) in 2007 and 1.042 (1.132-0.96) in 2015.
Overall, progress has been made toward narrowing the Black-White gap in cancer surgical opportunity and survival. Future efforts should be directed toward those specific cancers for which the Black-White gap continues. Additionally, it is worth addressing the Black-White gap regarding the use of (neo)adjuvant chemotherapy for CRC treatment.
自 2009 年以来，美国临床肿瘤学会（ASCO）一直致力于解决癌症治疗中的种族/民族差异问题。手术在癌症治疗中起着关键作用；然而，目前尚不清楚癌症手术中的种族/民族差异是否以及如何随时间发生变化。
本队列研究纳入了 9 年间（2007-2015 年）来自监测、流行病学和最终结果（SEER）-18 登记处的 1,113,256 名白人和黑人癌症患者，患者数据从 2007 年开始提取，以调整保险状况，到 2015 年结束，以获得至少 3 年的生存随访（截至 2018 年）。主要结局是手术干预。次要结局是使用（新）辅助化疗和癌症特异性生存（CSS）。在每种癌症类型和年份中，均测量了种族（黑人/白人）与结局的调整关联。
总体而言，黑人和白人患者的手术率差距缩小，从 2007 年的调整比值比（aOR）0.621（0.592-0.652）缩小到 2015 年的 0.734（0.702-0.768）。然而，在肺癌、乳腺癌、前列腺癌、食管癌和卵巢癌的手术率方面，种族差距仍然存在。在接受淋巴结转移手术的患者中，黑人结直肠癌（CRC）患者接受（新）辅助化疗的可能性低于白人患者。接受手术的黑人患者的 CSS 率比接受手术的白人患者更差。在乳腺癌患者中，整体趋势较窄，但持续存在，2007 年的调整危险比（aHR）为 1.224（1.278-1.173），2015 年为 1.042（1.132-0.96）。
总体而言，在缩小癌症手术机会和生存方面的黑人和白人差距方面已经取得了进展。未来的努力应针对那些黑人和白人差距仍然存在的特定癌症。此外，值得解决 CRC 治疗中（新）辅助化疗使用方面的黑人和白人差距问题。
