Brady Jacob S, Norouzi Armita, Konuthula Neeraja, Lam Austin, Marchiano Emily, Futran Neal, Barber Brittany
Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
Department of Otolaryngology-Head and Neck Surgery, Miller School of Medicine at the University of Miami, Miami, Florida, USA.
Head Neck. 2025 May;47(5):1512-1519. doi: 10.1002/hed.28075. Epub 2025 Jan 16.
The aim of this study was to compare the incidence of positive surgical margins (PSMs) between different races and sexes in a national cohort.
In this study, we analyzed the association between race and sex disparities and the incidence of PSMs based on data from the 2004-2016 National Cancer Database (NCDB). The NCDB includes deidentified data collected from over 1500 hospitals as part of the Commission on Cancer approvals program and represents over 70% of new cancer cases in the United States. This analysis provides minimally adjusted and further adjusted multivariate analyses of the incidence of positive surgical margins in OCSCC stratified by sex and race, disease characteristics, other demographics, comorbidities, and social determinants of health (SDOH).
The incidence of PSMs was found to be elevated in black males of any age, black males under the age of 45, and in Indigenous American and native Alaskan males under the age of 45, independent of clinicopathologic factors. Specifically, black patients had a significantly higher incidence of PSMs when controlling for age, subsite, stage, grade, LVI, and CDCS. Our results remained unchanged after adjusting for the SDOH variables of insurance coverage, level of education, income, metropolitan versus urban versus rural location, distance from treatment center, and facility type.
The findings of this study suggest that black males of any age, black males under 45, and Indigenous American and native Alaskan males under 45 have a higher incidence of PSMs, independent of clinicopathologic factors and SDOH. Our findings may help inform clinicians and hospitals of lapses in our healthcare system that perpetuate these inequities and further the goal of tackling disparities in surgical care.
本研究旨在比较全国队列中不同种族和性别的手术切缘阳性（PSM）发生率。
在本研究中，我们基于2004 - 2016年国家癌症数据库（NCDB）的数据，分析了种族和性别差异与PSM发生率之间的关联。NCDB包含从1500多家医院收集的去标识化数据，这些数据是癌症委员会批准项目的一部分，代表了美国超过70%的新发癌症病例。本分析提供了按性别和种族、疾病特征、其他人口统计学特征、合并症以及健康的社会决定因素（SDOH）分层的口腔癌前哨癌手术切缘阳性发生率的最小调整和进一步调整的多变量分析。
发现任何年龄的黑人男性、45岁以下的黑人男性以及45岁以下的美国原住民和阿拉斯加原住民男性的PSM发生率升高，与临床病理因素无关。具体而言，在控制年龄、亚部位、分期、分级、淋巴管浸润（LVI）和CDCS后，黑人患者的PSM发生率显著更高。在对保险覆盖范围、教育水平、收入、大都市与城市与农村位置、距治疗中心的距离以及机构类型等SDOH变量进行调整后，我们的结果保持不变。
本研究结果表明，任何年龄的黑人男性、45岁以下的黑人男性以及45岁以下的美国原住民和阿拉斯加原住民男性的PSM发生率较高，与临床病理因素和SDOH无关。我们的研究结果可能有助于告知临床医生和医院我们医疗保健系统中存在的失误，这些失误使这些不平等现象长期存在，并推动解决手术治疗差异这一目标的实现。
