Tran Ashley, Shiraga Sharon
Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
Surg Endosc. 2025 Jun 30. doi: 10.1007/s00464-025-11951-7.
Esophageal cancer is the sixth most common gastrointestinal cancer in the United States. Treatment for esophageal cancer depends on the extent of the disease but often includes surgery with or without chemoradiation. The aim of this study is to identify possible gender, racial, and socioeconomic disparities in treatment decisions and survival outcomes for patients with locally advanced esophageal cancer.
Locally advanced (stage IIA-IVA) esophageal cancer cases in adults (age ≥ 20 years) diagnosed between 2012 and 2021 were identified from the Surveillance, Epidemiology, and End Results database. Data regarding patient demographics, treatment strategies, and survival outcomes was collected. Multivariate logistic and Cox regression analyses were performed to evaluate the association between various patient characteristics and management patterns and survival.
A total of 10,823 cases were included in this study. Female (OR: 0.71, p < 0.001), Black (OR 0.33, p < 0.001), and Hispanic (OR: 0.75, p < 0.001) patients were less likely to be recommended surgery for their esophageal cancer. Among patients who were recommended surgery, Black race (OR: 0.062, p = 0.006) and Low SES (OR: 0.662, p = 0.007) were associated with a lower likelihood of surgery being performed. Female (OR: 0.74, p = 0.007) and Hispanic (OR 0.64, p = 0.003) patients were less likely to receive neoadjuvant therapy. Female (OR: 0.82, p = 0.040), Black (OR: 0.63, p = 0.018), and Low SES (OR: 0.734, p = 0.008) patients were less likely to receive adjuvant therapy. Female patients had improved OS (HR: 0.88, p < 0.001) and CSS (HR: 0.85, p = 0.003) whereas Black race (OS-HR: 1.32, p < 0.001, CSS-HR: 1.31, p < 0.001) and Low SES (OS-HR: 1.15, p < 0.001, CSS-HR: 1.17, p < 0.001) were associated with worse OS and CSS.
Significant differences in surgical management, administration of neoadjuvant and adjuvant therapy, OS, and CSS exist based on gender, race/ethnicity, and SES. Further research is needed to elucidate and ameliorate the possible causes of these disparities.
食管癌是美国第六大常见的胃肠道癌症。食管癌的治疗取决于疾病的程度，但通常包括手术，可联合或不联合放化疗。本研究的目的是确定局部晚期食管癌患者在治疗决策和生存结果方面可能存在的性别、种族和社会经济差异。
从监测、流行病学和最终结果数据库中识别出2012年至2021年间诊断的成人（年龄≥20岁）局部晚期（IIA-IVA期）食管癌病例。收集了患者人口统计学、治疗策略和生存结果的数据。进行多因素逻辑回归和Cox回归分析，以评估各种患者特征与管理模式及生存之间的关联。
本研究共纳入10823例病例。女性（比值比：0.71，p<0.001）、黑人（比值比0.33，p<0.001）和西班牙裔（比值比：0.75，p<0.001）患者因食管癌被推荐手术的可能性较小。在被推荐手术的患者中，黑人种族（比值比：0.062，p = 0.006）和低社会经济地位（比值比：0.662，p = 0.007）与手术实施可能性较低相关。女性（比值比：0.74，p = 0.007）和西班牙裔（比值比0.64，p = 0.003）患者接受新辅助治疗的可能性较小。女性（比值比：0.82，p = 0.040）、黑人（比值比：0.63，p = 0.018）和低社会经济地位（比值比：0.734）患者接受辅助治疗的可能性较小。女性患者的总生存期（风险比：0.88，p<0.001）和癌症特异性生存期（风险比：0.85，p = 0.003）有所改善，而黑人种族（总生存期风险比：1.32，p<0.001，癌症特异性生存期风险比：1.31，p<0.001）和低社会经济地位（总生存期风险比：1.15，p<0.001，癌症特异性生存期风险比：1.17，p<0.001）与较差的总生存期和癌症特异性生存期相关。
基于性别、种族/民族和社会经济地位，在手术管理、新辅助和辅助治疗的实施、总生存期和癌症特异性生存期方面存在显著差异。需要进一步研究以阐明并改善这些差异的可能原因。
