Department of Translational Research, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States.
Faculty of Medicine, Riga Stradins University, Riga, Latvia, United States.
Asian Pac J Cancer Prev. 2023 Mar 1;24(3):915-921. doi: 10.31557/APJCP.2023.24.3.915.
Asians and Pacific Islanders (API) exhibit increased incidence of nasopharyngeal carcinoma (NPC). However, they are often excluded when the disease is studied. Risk-factors and incidence are well-researched while cancer-specific mortality trends remain unclear. We aimed to determine whether insurance status modifies the association between race and cancer-specific mortality in NPC patients.
This retrospective cohort study used secondary data analysis from the Surveillance, Epidemiology, and End Results Program database. Patients ≥18 years with histologically confirmed primary NPC from 2007 - 2016 were included. The main outcome assessed was 5-year survival and the main exposure variable was race (API, white, black). Insurance status was classified into uninsured, any Medicaid, and insured (with any insurance). Potential confounders included age, sex, marital status, stage at diagnosis, and surgical treatment. Adjusted Cox regression analysis was used to calculate hazard ratios (HR) and corresponding 95% confidence intervals (CI).
1610 patients were included (72.98% male, 27.02% female). 49.8% were API, 40.5% were Whites, and 9.8% Blacks. Maximum follow-up was 5-years. The adjusted hazards of 5-year cancer-specific death for API and Blacks compared with Whites were 0.77 (95% CI 0.62 - 0.96) and 0.92 (95% CI 0.65 - 1.31), respectively. Cases decreased with age in API and Blacks. 8.2% of cases had localized disease, 45.3% had local spread, and 44.6% had distant metastasis. Insurance status did not modify the association between race and mortality.
Race is an important prognostic factor to account for in NPC patients. Investigating risk-factors and subtypes stratified by race may explain our findings.
亚洲人和太平洋岛民（API）患有鼻咽癌（NPC）的发病率增加。然而，在研究这种疾病时，他们往往被排除在外。风险因素和发病率研究得很好，而癌症特异性死亡率趋势尚不清楚。我们旨在确定保险状况是否会改变种族与 NPC 患者癌症特异性死亡率之间的关联。
本回顾性队列研究使用了来自监测、流行病学和最终结果计划数据库的二次数据分析。纳入了 2007 年至 2016 年间经组织学证实的原发性 NPC 且年龄≥18 岁的患者。主要评估结果是 5 年生存率，主要暴露变量是种族（API、白人、黑人）。保险状况分为无保险、任何医疗补助和有保险（任何保险）。潜在混杂因素包括年龄、性别、婚姻状况、诊断时的分期和手术治疗。采用调整后的 Cox 回归分析计算危险比（HR）和相应的 95%置信区间（CI）。
共纳入 1610 例患者（72.98%为男性，27.02%为女性）。49.8%为 API，40.5%为白人，9.8%为黑人。最长随访时间为 5 年。与白人相比，API 和黑人患者 5 年癌症特异性死亡的调整后 HR 分别为 0.77（95%CI 0.62-0.96）和 0.92（95%CI 0.65-1.31）。API 和黑人患者的病例数随年龄增长而减少。8.2%的病例为局限性疾病，45.3%的病例为局部扩散，44.6%的病例为远处转移。保险状况并未改变种族与死亡率之间的关联。
种族是 NPC 患者预后的一个重要因素。按种族分层调查风险因素和亚型可能解释我们的发现。
