Effects of Cancer Stage and Treatment Differences on Racial Disparities in Survival From Colon Cancer: A United States Population-Based Study.
Effects of Cancer Stage and Treatment Differences on Racial Disparities in Survival From Colon Cancer: A United States Population-Based Study.
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DOI：
10.1053/j.gastro.2016.01.030
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发表时间：
2016-05
期刊：
影响因子：
29.4
通讯作者：
Yang H
中科院分区：
文献类型：
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作者：
Lai Y;Wang C;Civan JM;Palazzo JP;Ye Z;Hyslop T;Lin J;Myers RE;Li B;Jiang B;Sama A;Xing J;Yang H
我们评估了黑人与白色结肠癌患者的治疗差异，并根据癌症分期评估了其对生存率的影响。我们收集了来自监测、流行病学和最终结果（SEER）-医疗保险数据库的数据，并确定了1998年至2009年诊断为结肠癌的6190名黑人和61,951名白色患者，并随访至2011年。根据人口统计学（年龄、性别、诊断年份和SEER登记）、肿瘤表现（人口统计学加合并症、肿瘤分期、分级和大小）和治疗（表现加治疗）变量，使用最小距离策略将三组6190名白色患者与同一组6190名黑人患者顺序匹配。我们进行了敏感性分析，以探讨社会经济地位的影响，在一个子队列，其中包括2000名随机选择的黑人患者。使用logistic回归模型评估治疗的种族差异;使用Kaplan-Meier方法和考克斯比例风险模型评估其对种族生存差异的影响。在患者的人口统计学变量匹配后，黑人和白色患者之间5年生存率的绝对差异为8.3（白色，5年生存率为59.2%;黑人，5年生存率为50.9%）（P<.0001）;该值显著下降至5.0%（P<0.0001），当患者匹配肿瘤表现后，降低至4.9%（P<0.0001），当患者匹配治疗时。因此，治疗差异占黑人和白色患者生存率差异8.3%的0.1%。在患者的肿瘤表现匹配后，几乎所有类型的治疗都观察到种族差异;晚期癌症患者（III或IV期，差异高达11.1%）与早期癌症患者（I或II期，差异高达4.3%）的差异最为突出。在患者匹配治疗后，与早期癌症相比，晚期黑人与白色患者的差异减少得更大。在敏感性分析中，人口统计学匹配后，5年种族生存差异为7.7%，低于完整队列中观察到的8.3%。这种减少可能是由于子队列和完整队列之间在人口统计学匹配中未包括的那些变量中的差异。在将社会经济状况纳入人口统计学匹配后，该值降至6.5%（P=.0001）。肿瘤表现匹配后，差异显著降低至2.8%（P= 0.090），但治疗匹配后未进一步降低。我们观察到黑人结肠癌患者与白色结肠癌患者在治疗和生存方面存在显著差异。生存率的差异似乎受到诊断时肿瘤表现的影响比治疗更大。治疗差异对晚期癌症患者生存差异的影响大于早期癌症患者。
We evaluated differences in treatment of black vs white patients with colon cancer and assessed their effects on survival, based on cancer stage. We collected data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database and identified 6190 black and 61,951 white patients with colon cancer diagnosed from 1998 through 2009 and followed through 2011. Three sets of 6190 white patients were sequentially matched, using a minimum distance strategy, to the same set of 6190 black patients based on demographic (age, sex, diagnosis year, and SEER registry), tumor presentation (demographic plus comorbidities, tumor stage, grade, and size), and treatment (presentation plus therapies) variables. We conducted sensitivity analyses to explore the effects of socioeconomic status in a sub-cohort that included 2000 randomly selected black patients. Racial differences in treatment were assessed using a logistic regression model; their effects on racial survival disparity were evaluated using Kaplan-Meier method and Cox proportional hazards model. After patients were matched for demographic variables, the absolute 5 y difference in survival between black and white patients was 8.3% (white, 59.2% 5 y survival; blacks, 50.9% 5 y survival) (P<.0001); this value decreased significantly, to 5.0% (P<.0001), after patients were matched for tumor presentation, and decreased to 4.9% (P<.0001) when patients were matched for treatment. Differences in treatment therefore accounted for 0.1% of the 8.3% difference in survival between black and white patients. After patients were matched for tumor presentation, racial disparities were observed in almost all types of treatment; the disparities were most prominent for patients with advanced-stage cancer (stages III or IV, up to 11.1% difference) vs early-stage cancer (stages I or II, up to 4.3% difference). After patients were matched for treatment, there was a greater reduction in disparity for black vs white patients with advanced-stage compared with early-stage cancer. In sensitivity analyses, the 5 y racial survival disparity was 7.7% after demographic match, which was less than 8.3% observed in the complete cohort. This reduction was likely due to the differences between the sub-cohort and the complete cohort in those variables that were not included in the demographic match. This value was reduced to 6.5% (P=.0001) after socioeconomic status was included in the demographic match. The difference decreased significantly to 2.8% (P=.090) after tumor presentation match, but was not further reduced after treatment match. We observed significant disparities in treatment and survival of black vs white patients with colon cancer. The disparity in survival appears to have been more strongly affected by tumor presentation at diagnosis than treatment. The effects of treatment differences on disparities in survival were greater for patients with advanced-stage, vs early-stage, cancer.