Klingbeil Kyle D, Dillon Dustin L, Zarrinkhoo Erfan, Bechay Kirollos, Park Joon Y, Rook Jordan M, Mederos Michael A, Girgis Mark D, Chen Keren, Chen Kuan-Ting, Bastani Roshan, Manouchehr-Pour Shawdi, Dubé Priyanka, Viragh Karoly, Thomas Mariam, Chiu Victor, Kadera Brian E
Division of Surgical Oncology, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California.
Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California.
Cancer Epidemiol Biomarkers Prev. 2025 Jan 9;34(1):75-84. doi: 10.1158/1055-9965.EPI-23-1224.
Various population-based studies have shown Hispanic/Latino ethnicity is a risk factor for worse survival in patients with gastric cancer linked to disparate access to care. We aimed to address whether Hispanic patients treated within safety-net hospital systems continue to experience this survival deficit compared to non-Hispanic patients.
We performed a retrospective cohort study comparing survival between Hispanic and non-Hispanic patients diagnosed with gastric adenocarcinoma between January 1, 2016, and December 31, 2020, within Los Angeles County's safety-net hospital system. Gastric cancer-specific survival was compared between the two cohorts using the Kaplan-Meier estimate and Cox proportional-hazards regression model.
In total, 448 patients who received care from five medical centers were included; 348 (77.7%) patients self-identified as Hispanic and 100 (22.3%) as non-Hispanic. Mean follow-up time was 2.0 years (median 0.91 years, IQR, 0.34-2.5 years). Hispanic patients were found to be diagnosed at a younger age (55.6 vs. 60.7 years, P < 0.01), demonstrate higher state area deprivation index (6.4 vs. 5.0, P < 0.01), and present with metastatic disease (59.8% vs. 45%, P = 0.04). After adjusting social and oncologic variables, Hispanic ethnicity remained an independent risk factor for worse survival [HR 1.56, (95% CI, 1.06-2.28); P = 0.02].
Hispanic patients treated within a large, multicenter safety-net hospital system experience worse survival compared to non-Hispanic patients. This suggests ethnic disparities exist within safety-net hospital systems, independent of known clinicopathologic factors.
Improving outcomes for Hispanic patients with gastric cancer requires future efforts aimed at defining and addressing these unidentified barriers to care. See related In the Spotlight, p. 12.
多项基于人群的研究表明，西班牙裔/拉丁裔种族是胃癌患者生存情况较差的一个风险因素，这与医疗服务可及性的差异有关。我们旨在探讨在安全网医院系统接受治疗的西班牙裔患者与非西班牙裔患者相比，是否仍然存在这种生存劣势。
我们进行了一项回顾性队列研究，比较2016年1月1日至2020年12月31日期间在洛杉矶县安全网医院系统内被诊断为胃腺癌的西班牙裔和非西班牙裔患者的生存率。使用Kaplan-Meier估计法和Cox比例风险回归模型比较两个队列的胃癌特异性生存率。
总共纳入了448名在五个医疗中心接受治疗的患者；348名（77.7%）患者自我认定为西班牙裔，100名（22.3%）为非西班牙裔。平均随访时间为2.0年（中位数0.91年，四分位间距，0.34 - 2.5年）。发现西班牙裔患者诊断时年龄较小（55.6岁对60.7岁，P < 0.01），州地区贫困指数较高（6.4对5.0，P < 0.01），且出现转移性疾病的比例较高（59.8%对45%，P = 0.04）。在调整社会和肿瘤学变量后，西班牙裔种族仍然是生存情况较差的独立风险因素[风险比1.56，（95%置信区间，1.06 - 2.28）；P = 0.02]。
在一个大型多中心安全网医院系统接受治疗的西班牙裔患者与非西班牙裔患者相比，生存情况更差。这表明安全网医院系统内存在种族差异，且独立于已知的临床病理因素。
改善西班牙裔胃癌患者的治疗结局需要未来努力确定并解决这些未明确的医疗障碍。见相关的《聚焦》，第12页。
