Dominitz J A, Samsa G P, Landsman P, Provenzale D
Center for Health Services Research and Development, Veterans Affairs Medical Center, Durham, North Carolina, USA.
Cancer. 1998 Jun 15;82(12):2312-20. doi: 10.1002/(sici)1097-0142(19980615)82:12<2312::aid-cncr3>3.0.co;2-u.
The aim of this study was to assess the influence of race on the treatment and survival of patients with colorectal carcinoma.
This retrospective cohort study included all white or black male veterans given a new diagnosis of colorectal carcinoma in 1989 at Veterans Affairs Medical Centers nationwide. After adjusting for patient demographics, comorbidity, distant metastases, and tumor location, the authors determined the likelihood of surgical resection, chemotherapy, radiation therapy, and death in each case.
Of the 3176 veterans identified, 569 (17.9%) were black. Bivariate analyses and logistic regression revealed no significant differences in the proportions of patients undergoing surgical resection (70% vs. 73%, odds ratio 0.92, 95% confidence interval 0.74-1.15), chemotherapy (23% vs. 23%, odds ratio 0.99, 95% confidence interval 0.78-1.24), or radiation therapy (17% vs. 16%, odds ratio 1.10, 95% confidence interval 0.85-1.43) for black versus white patients. Five-year relative survival rates were similar for black and white patients (42% vs. 39%, respectively; P=0.16), though the adjusted mortality risk ratio was modestly increased (risk ratio 1.13, 95% confidence interval 1.01-1.28).
Overall, race was not associated with the use of surgery, chemotherapy, or radiation therapy in the treatment of colorectal carcinoma among veterans seeking health care at Veterans Affairs Medical Centers. Although mortality from all causes was higher among black veterans with colorectal carcinoma, this finding may be attributed to underlying racial differences associated with survival. This study suggests that when there is equal access to care, there are no differences with regard to race.
本研究旨在评估种族对结直肠癌患者治疗及生存的影响。
这项回顾性队列研究纳入了1989年在全国退伍军人事务医疗中心新诊断为结直肠癌的所有白种或黑种男性退伍军人。在对患者人口统计学特征、合并症、远处转移及肿瘤位置进行校正后，作者确定了每例患者接受手术切除、化疗、放疗及死亡的可能性。
在确定的3176名退伍军人中，569名（17.9%）为黑人。双变量分析及逻辑回归显示，黑种人与白种人患者在接受手术切除（70%对73%，优势比0.92，95%置信区间0.74 - 1.15）、化疗（23%对23%，优势比0.99，95%置信区间0.78 - 1.24）或放疗（17%对16%，优势比1.10，95%置信区间0.85 - 1.43）的比例上无显著差异。黑种人和白种人患者的5年相对生存率相似（分别为42%和39%；P = 0.16），尽管校正后的死亡风险比略有升高（风险比1.13，95%置信区间1.01 - 1.28）。
总体而言，在退伍军人事务医疗中心寻求医疗服务的退伍军人中，种族与结直肠癌治疗中手术、化疗或放疗的使用无关。尽管患有结直肠癌的黑人退伍军人全因死亡率较高，但这一发现可能归因于与生存相关的潜在种族差异。本研究表明，当获得同等医疗服务时，种族方面不存在差异。
