The Latinx Disparity in Surgery for Kidney Cancer: Data from The South Texas Region.
The Latinx Disparity in Surgery for Kidney Cancer: Data from The South Texas Region.
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DOI：
10.52733/kcj20n1-a1
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发表时间：
2022-03
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影响因子：
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通讯作者：
Kaushik, Dharam
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作者：
Dursun, Furkan;Patel, Rahul S;Hui, Dawn;Wang, Hanzhang;Mansour, Ahmed;Pruthi, Deepak;Alonso, David G;Jayakumar, Lalithapriya;Rodriguez, Ronald;Svatek, Robert S;Liss, Michael A;Kaushik, Dharam
德克萨斯州南部地区以拉丁裔人口为主，肾细胞癌 (RCC) 的发病率非常高，其中包括肿瘤延伸到主要血管的肿瘤，称为静脉瘤血栓 (VTT)。目前没有关于拉丁裔 VTT 患者结局的数据，因为大多数已发表的研究主要来自白人群体。因此，我们进行这项研究是为了满足一个紧迫的、未满足的需求。我们回顾了 2015 年至 2020 年间接受根治性肾切除术并去除 VTT（称为肿瘤血栓切除术）的患者。我们收集了患者的人口统计、临床、病理特征和结果的数据。使用单变量和多变量 Cox 回归分析来评估种族与疾病进展或生存之间的关联。我们确定了 112 名患者，其中 67 名 (62%) 是拉丁裔，41 名 (38%) 是非拉丁裔。大约 60% 的患者患有 II-IV 级 VTT；拉丁裔的肿瘤血栓水平较高（p=0.046）。与非拉丁裔患者相比，拉丁裔患者的无保险率较高（11% vs. 27%，p=0.04），并且术后失访的可能性更大（22.4% vs. 13.3%，p=0.23）。接受全身治疗的拉丁裔人数较少（28% vs. 42%；p=0.13）。整个队列的 90 天死亡率为 3.8%。德克萨斯州南部地区的拉丁裔人群就诊较晚，血栓水平较高，无法获得全身治疗。鉴于有症状的疾病，如果可行的话，手术治疗是他们唯一的选择。我们的结果强调了不同的治疗模式，需要进一步调查和医疗保健政策的改变。
The South Texas region, with a predominantly Latinx population, has a very high incidence of renal cell carcinoma (RCC), including those with tumor extending into the major blood vessels called venous tumor thrombus (VTT). There is currently no data on outcomes of Latinx patients with VTT as most published studies are from predominantly Caucasian population. Therefore, we performed this study to fill an urgent, unmet need. We reviewed patients who underwent radical nephrectomy with removal of VTT (called tumor thrombectomy) between 2015 and 2020. We collected data on demographics, clinical, pathological characteristics and outcomes of patients. Univariate and multivariate Cox regression analyses were used to evaluate the associations between ethnicity and disease progression or survival. We identified 112 patients, of which 67 (62%) were Latinx, and 41 (38%) were non-Latinx. Approximately 60% of patients had Level II-IV VTT; Latinx presented with a higher level of tumor thrombus (p=0.046). Latinx patients had a higher rate of no insurance (11% vs. 27%, p=0.04) and were more likely to lost to follow-up after surgery (22.4% vs. 13.3%, p=0.23) compared to non-Latinx. Fewer Latinx received systemic therapy (28% vs. 42%; p=0.13). Ninety-day mortality for the entire cohort was 3.8%. The Latinx population in the South Texas region present late, with advanced thrombus level, and do not have access to systemic therapy. Given symptomatic disease, surgical treatment, if feasible, is their only option. Our results highlight disparate treatment patterns which require further investigation and health-care policy changes.