Ramirez Juan C, Alvarez Juan C, Cifuentes Phillip, Castro Grettel, Barengo Noel C
Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, USA.
Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, USA.
Cureus. 2023 Sep 20;15(9):e45641. doi: 10.7759/cureus.45641. eCollection 2023 Sep.
Colorectal cancer is one of the most common malignancies diagnosed in the United States, with 126,240 new cases diagnosed in 2020. Past studies have shown that disparities may exist between certain patient populations, but it is unknown how they are affected over time as treatments evolve. The purpose of this study was to determine whether the decade of treatment modifies the association between race and five-year survival in adults diagnosed and treated for malignant colorectal adenocarcinomas since the 1970s.
This was a non-concurrent retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. The inclusion criteria involved patients with primary malignant colorectal adenocarcinoma between the years 1975 and 2018. Exclusion criteria included previous malignancies or missing information on any of the variables. The exposure variable was the patient's race, and the main outcome variable was average five-year survival rates. The effect modifier was the time period in which the patient received treatment. The covariates of the study included age, sex, Hispanic status, surgical intervention recommendation, and disease stage. Unadjusted and adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated using Cox regression models.
As the interaction term between race/ethnicity and year of diagnosis was statistically significant, the data were stratified according to year of diagnosis. Black patients in both time periods had a higher mortality rate from malignant colorectal carcinoma after adjustment for the covariates (1975-1990: HR 1.10, 95% CI 1.06-1.15; 1991-2018: HR 1.19, 95% CI 1.16-1.23) when compared with White patients. American Indian, Alaskan Native, and Asian patients were found to have lower mortality in both time periods when compared with White patients (1975-1990: HR 0.90, 95% CI 0.85-0.95; 1991-2018: HR 0.93, 95% CI 0.89-0.96).
Our data found that despite the evolution in the standard of care treatment for malignant colorectal adenocarcinoma since the year 1975, Black patients had lower five-year survival rates when compared with their White counterparts as well as increased rates of being diagnosed with this disease. Overall, addressing these disparities in colorectal cancer outcomes is critical for improving public health and reducing healthcare costs.
结直肠癌是美国诊断出的最常见恶性肿瘤之一，2020年有126,240例新发病例。过去的研究表明，某些患者群体之间可能存在差异，但随着治疗方法的演变，这些差异如何随时间受到影响尚不清楚。本研究的目的是确定自20世纪70年代以来，治疗的十年是否会改变被诊断并接受恶性结直肠腺癌治疗的成年人中种族与五年生存率之间的关联。
这是一项非同期回顾性队列研究，使用了美国国立癌症研究所监测、流行病学和最终结果（SEER）数据库的数据。纳入标准包括1975年至2018年间患有原发性恶性结直肠腺癌的患者。排除标准包括既往有恶性肿瘤或任何变量信息缺失。暴露变量是患者的种族，主要结局变量是平均五年生存率。效应修饰因素是患者接受治疗的时间段。该研究的协变量包括年龄、性别、西班牙裔身份、手术干预建议和疾病分期。使用Cox回归模型计算未调整和调整后的风险比（HR）以及相应的95%置信区间（CI）。
由于种族/族裔与诊断年份之间的交互项具有统计学意义，因此数据按诊断年份进行了分层。在对协变量进行调整后，两个时间段的黑人患者与白人患者相比，恶性结直肠癌的死亡率更高（1975 - 1990年：HR 1.10，95% CI 1.06 - 1.15；1991 - 2018年：HR 1.19，95% CI 1.16 - 1.23）。与白人患者相比，美洲印第安人、阿拉斯加原住民和亚洲患者在两个时间段内的死亡率均较低（1975 - 1990年：HR 0.90，95% CI 0.85 - 0.95；1991 - 2018年：HR 0.93，95% CI 0.89 - 0.96）。
我们的数据发现，尽管自1975年以来恶性结直肠腺癌的护理标准治疗有所演变，但与白人患者相比，黑人患者的五年生存率较低，且被诊断出患有这种疾病的比率也有所增加。总体而言，解决结直肠癌结局中的这些差异对于改善公众健康和降低医疗成本至关重要。
