Alsoof Daniel, Kasthuri Viknesh, Homer Alexander, Glueck Jacob, McDonald Christopher L, Kuris Eren O, Daniels Alan H
Orthop Rev (Pavia). 2023 Apr 11;15:74118. doi: 10.52965/001c.74118. eCollection 2023.
Ewing Sarcoma (ES) is an aggressive tumor affecting adolescents and young adults. Prior studies investigated the association between rurality and outcomes, although there is a paucity of literature focusing on ES.
This study aims to determine whether ES patients in rural areas are subject to adverse outcomes.
This study utilized the Surveillance, Epidemiology, and End Results (SEER) database. A Poisson regression model was used with controls for race, sex, median county income, and age to determine the association between rurality and tumor size. A multivariate Cox Proportional Hazard Model was utilized, controlling for age, race, gender, income, and tumor size.
There were 868 patients eligible for analysis, with a mean age of 14.14 years. Of these patients, 97 lived in rural counties (11.18%). Metropolitan areas had a 9.50% smaller tumor size (p<0.0001), compared to non-metropolitan counties. Patients of Black race had a 14.32% larger tumor size (p<0.0001), and male sex was associated with a 15.34% larger tumor size (p<0.0001). The Cox Proportional Hazard model estimated that metropolitan areas had a 36% lower risk of death over time, compared to non-metropolitan areas (HR: 0.64, p ≤ 0.04).
Patients in metropolitan areas had a smaller tumor size at time of diagnosis and had a more favorable survival rate for cancer-specific mortality compared to patients residing in rural areas. Further work is needed to examine interventions to reduce this discrepancy and investigate the effect of extremely rural and urban settings and why racial disparities occur.
尤因肉瘤（ES）是一种侵袭性肿瘤，主要影响青少年和青年。先前的研究调查了农村地区与治疗结果之间的关联，尽管关注ES的文献较少。
本研究旨在确定农村地区的ES患者是否会出现不良预后。
本研究使用了监测、流行病学和最终结果（SEER）数据库。采用泊松回归模型，并对种族、性别、县收入中位数和年龄进行控制，以确定农村地区与肿瘤大小之间的关联。使用多变量Cox比例风险模型，控制年龄、种族、性别、收入和肿瘤大小。
有868名患者符合分析条件，平均年龄为14.14岁。其中，97名患者居住在农村县（11.18%）。与非大都市县相比，大都市地区的肿瘤大小小9.50%（p<0.0001）。黑人患者的肿瘤大小大14.32%（p<0.0001），男性患者的肿瘤大小大15.34%（p<0.0001）。Cox比例风险模型估计，与非大都市地区相比，大都市地区随着时间推移的死亡风险低36%（HR：0.64，p≤0.04）。
与居住在农村地区的患者相比，大都市地区的患者在诊断时肿瘤较小，癌症特异性死亡率的生存率更有利。需要进一步开展工作，以研究减少这种差异的干预措施，并调查极端农村和城市环境的影响以及种族差异产生的原因。
