Gastrointestinal Malignancies: When Does Race Matter?
Gastrointestinal Malignancies: When Does Race Matter?
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DOI：
10.1016/j.jamcollsurg.2009.08.007
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发表时间：
2009-11-01
影响因子：
5.2
通讯作者：
Zervos, Emmanuel E.
中科院分区：
文献类型：
--
作者：
Fitzgerald, Timothy L.;Bradley, Cathy J.;Zervos, Emmanuel E.
背景：非裔美国人的胃肠道癌症生存率较低。我们假设，社会经济地位可以解释这种disparity.Study设计：四年的人口为基础的医疗保险和医疗补助行政索赔文件合并与密歇根州肿瘤登记处。确定了18,260例结直肠癌（n = 13,001）、胰腺癌（n = 2,427）、胃癌（n = 1,739）和食管癌（n = 1,093）患者的数据。研究了三个结果：晚期诊断的可能性，诊断后手术的可能性和生存率。采用双变量分析比较非裔美国人和白人患者的分期和手术情况。采用考克斯比例风险模型评价生存率差异。统计学显著性定义为p <0.05。结果：在未校正的分析中，相对于白人患者，非裔美国结直肠癌和食管癌患者更可能出现转移性疾病，更不可能接受手术，并且在研究期间更不可能存活（p < 0.05）。在多变量分析中，非裔美国患者死于结直肠癌的可能性高于白人患者。然而，当考虑到晚期和手术时，这种差异并不持续（风险比= 1.15，95% CI = 1.06至1.24）。食管癌、胃癌或胰腺癌患者的生存率无种族差异。结论：这些数据表明，筛查和手术率的提高可能会减少非裔美国人和白人患者结直肠癌预后的差异。但种族对胰腺癌、食管癌或胃癌患者的生存率几乎没有影响。（美国科尔外科杂志2009;209：645-652。(C)2009年美国外科医生学会）
BACKGROUND: African Americans have a poorer survival from gastrointestinal cancers. We hypothesized that socioeconomic status may explain much of this disparity.STUDY DESIGN: Four years of population-based Medicare and Medicaid administrative claims Files were merged with the Michigan Tumor Registry. Data were identified for 18,260 patients with colorectal (n = 13,001), pancreatic (n = 2,427), gastric (n = 1,739), and esophageal (n = 1,093) cancer. Three outcomes were studied: the likelihood of late stage diagnosis, the likelihood of surgery after diagnosis, and survival. Bivariate analysis was used to compare stage and operation between African-American and Caucasian patients. Cox proportional hazard models were used to evaluate differences in survival. Statistical significance was defined as p < 0.05.RESULTS: In unadjusted analyses, relative to Caucasian patients, African-American patients with colorectal and esophageal cancer were more likely to present with metastatic disease, were less likely to have surgery, and were less likely to survive during the study period (p < 0.05). In a multivariate analysis, African-American patients had a higher likelihood of death from colorectal cancer than Caucasian patients. This difference, however, did not persist when late stage and surgery were taken into account (hazard ratio = 1.15, 95% CI = 1.06 to 1.24). No racial differences in survival were observed among patients with esophagus, gastric, or pancreatic cancer.CONCLUSIONS: These data suggest that improvements in screening and rates of operation may reduce differences in colorectal cancer outcomes between African-American and Caucasian patients. But race has little influence on survival of patients with pancreatic, esophageal, or gastric cancer. (J Am Coll Surg 2009;209:645-652. (C) 2009 by the American College of Surgeons)