Jindani Rajika, Rodriguez-Quintero Jorge Humberto, Loh Isaac, Ha Grace, Olivera Justin, Rosario Justin, Zhu Roger, Kamel Mohamed K, Vimolratana Marc, Chudgar Neel P, Stiles Brendon M
Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Divison of Thoracic and Foregut Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Eur J Cardiothorac Surg. 2024 Dec 26;67(1). doi: 10.1093/ejcts/ezae462.
The benefits of neoadjuvant therapy prior to surgery for patients with locally advanced oesophageal cancer have been well established by multiple trials. However, there may be socioeconomic barriers impacting equitable administration. We aim to identify whether disparities exist in the uptake of neoadjuvant therapy among patients with loco-regional oesophageal cancer.
We queried the National Cancer Database to identify patients with clinical stage II-III oesophageal cancer who underwent surgical resection (2006-2020). Logistic regression was performed to identify associations between sociodemographic factors and uptake of neoadjuvant therapy. In propensity score-matched groups, survival was evaluated using the Kaplan-Meier method.
Among 19 748 clinical stage II-III patients, 85% (n = 16 781) received neoadjuvant therapy and 15% (n = 2967) underwent upfront surgery. Rates of neoadjuvant uptake increased over time. On multivariable analysis after adjusting by clinical stage, factors associated with lower rates of neoadjuvant therapy included older age (age ≥70, adjusted odds ratio 0.52; 95% confidence interval 0.47-0.57; P < 0.001), female sex (0.76; 0.69-0.85; P < 0.001), Black race (0.77; 0.63-0.94; P = 0.009), more comorbidities (0.76; 0.65-0.85; P < 0.001) and government rather than private insurance (0.84; 0.76-0.93; P < 0.001). In a propensity-matched cohort accounting for these variables, neoadjuvant treatment was associated with improved 5-year overall survival compared to upfront surgery (41.1% vs 35.4%, P < 0.001).
Several sociodemographic factors are associated with the delivery of neoadjuvant therapy in patients with oesophageal cancer, including age, sex, race, and insurance status. Interventions can be put into place to target vulnerable patients and ensure equitable delivery of care.
多项试验已充分证实，新辅助治疗对局部晚期食管癌患者术前治疗的益处。然而，可能存在社会经济障碍影响公平实施。我们旨在确定局部区域食管癌患者在接受新辅助治疗方面是否存在差异。
我们查询了国家癌症数据库，以确定接受手术切除的临床II - III期食管癌患者（2006 - 2020年）。进行逻辑回归分析，以确定社会人口学因素与新辅助治疗接受情况之间的关联。在倾向评分匹配组中，使用Kaplan - Meier方法评估生存率。
在19748例临床II - III期患者中，85%（n = 16781）接受了新辅助治疗，15%（n = 2967）接受了直接手术。新辅助治疗的接受率随时间增加。在按临床分期调整后的多变量分析中，与新辅助治疗率较低相关的因素包括年龄较大（年龄≥70岁，调整后的比值比为0.52；95%置信区间为0.47 - 0.57；P < 0.001）、女性（0.76；0.69 - 0.85；P < 0.001）、黑人种族（0.77；0.63 - 0.94；P = 0.009）、更多合并症（0.76；0.65 - 0.85；P < 0.001）以及政府保险而非私人保险（0.84；0.76 - 0.93；P < 0.001）。在考虑这些变量的倾向匹配队列中，与直接手术相比，新辅助治疗与改善5年总生存率相关（41.1%对35.4%，P < 0.001）。
食管癌患者接受新辅助治疗与几个社会人口学因素相关，包括年龄、性别、种族和保险状况。可以采取干预措施针对弱势患者，确保公平提供治疗。
