Washington Caretia J, Lattimore Chayil C, Brown Jimmy J, Silver Natalie L, Braithwaite Dejana, Fredenburg Kristianna M, Karanth Shama D
Department of Epidemiology, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, Florida.
Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida.
Cancer Res Commun. 2025 Aug 1;5(8):1310-1318. doi: 10.1158/2767-9764.CRC-25-0239.
A disparity persists in advanced-stage laryngeal cancer outcomes, in which Black patients experience lower survival rates. We examined real-world treatment patterns and outcomes by race and ethnicity in patients with advanced-stage laryngeal cancer in Florida. Data were abstracted from the Florida Cancer Data System on non-Hispanic (NH)-White, Hispanic, and NH-Black patients with advanced-stage laryngeal cancer from 2009 to 2020. Kaplan-Meier curves estimated survival by race and ethnicity. Multivariable Cox proportional hazard models calculated HRs and 95% confidence intervals (95% CI) to examine the association of race and ethnicity with treatment receipt and mortality. Cox proportional hazard models were adjusted for sociodemographic and tumor characteristics. A total of 4,316 participants with advanced-stage laryngeal cancer (75.3% NH-White, 13.1% Hispanic, and 11.6% NH-Black) were included in the analysis. In age- and sex-adjusted models, NH-Black patients had a higher risk of death (HR = 1.21; 95% CI, 1.08-1.35) compared with NH-White patients, whereas Hispanic patients had a lower risk (HR = 0.80; 95% CI, 0.71-0.90). After controlling for sociodemographic factors, mortality differences between NH-Black and NH-White patients were not statistically significant (HR = 1.12; 95% CI, 1.00-1.26). However, in treatment-stratified analyses, specifically in patients who received chemoradiation, NH-Black patients had a higher risk of death (HR = 1.25; 95% CI, 1.02-1.52) compared with NH-White patients. In conclusion, NH-Black patients with advanced-stage laryngeal cancer who underwent chemoradiation had higher mortality compared with NH-White patients, whereas Hispanic patients had lower mortality. Investigating factors such as healthcare access, comorbidities, and treatment response may help address these disparities.
This study provides important insight into racial and ethnic disparities in treatment outcomes and mortality risk among patients with advanced-stage laryngeal cancer in a real-world setting. Our findings underscore the need for a comprehensive approach to understanding outcome differences, considering the interplay of healthcare access, clinical factors, and treatment quality that influence patient care and survival.
晚期喉癌的治疗结果存在差异，黑人患者的生存率较低。我们研究了佛罗里达州晚期喉癌患者按种族和族裔划分的实际治疗模式和结果。数据取自佛罗里达癌症数据系统，涉及2009年至2020年患有晚期喉癌的非西班牙裔（NH）白人、西班牙裔和NH黑人患者。采用Kaplan-Meier曲线按种族和族裔估计生存率。多变量Cox比例风险模型计算风险比（HR）和95%置信区间（95%CI），以检验种族和族裔与治疗接受情况和死亡率之间的关联。Cox比例风险模型根据社会人口统计学和肿瘤特征进行了调整。共有4316名晚期喉癌患者（75.3%为NH白人，13.1%为西班牙裔，11.6%为NH黑人）纳入分析。在年龄和性别调整模型中，与NH白人患者相比，NH黑人患者的死亡风险更高（HR = 1.21；95%CI，1.08 - 1.35），而西班牙裔患者的死亡风险较低（HR = 0.80；95%CI，0.71 - 0.90）。在控制社会人口统计学因素后，NH黑人和NH白人患者之间的死亡率差异无统计学意义（HR = 1.12；95%CI，1.00 - 1.26）。然而，在治疗分层分析中，特别是在接受放化疗的患者中，与NH白人患者相比，NH黑人患者的死亡风险更高（HR = 1.25；95%CI，1.02 - 1.52）。总之，接受放化疗的晚期喉癌NH黑人患者的死亡率高于NH白人患者，而西班牙裔患者的死亡率较低。研究医疗保健可及性、合并症和治疗反应等因素可能有助于解决这些差异。
本研究为现实环境中晚期喉癌患者治疗结果和死亡风险的种族和族裔差异提供了重要见解。我们的研究结果强调，需要采取综合方法来理解结果差异，考虑影响患者护理和生存的医疗保健可及性、临床因素和治疗质量之间的相互作用。
