Deprivation and Colorectal Cancer Surgery: Longer-Term Survival Inequalities are Due to Differential Postoperative Mortality Between Socioeconomic Groups
Deprivation and Colorectal Cancer Surgery: Longer-Term Survival Inequalities are Due to Differential Postoperative Mortality Between Socioeconomic Groups
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DOI：
10.1245/s10434-013-2959-9
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发表时间：
2013-07-01
影响因子：
3.7
通讯作者：
Morrison, David S.
中科院分区：
文献类型：
--
作者：
Oliphant, Raymond;Nicholson, Gary A.;Morrison, David S.
在2001年至2004年期间，苏格兰西部16家医院共4，296例接受结直肠癌手术的患者从前瞻性维护的区域审计数据库中确定。术后死亡率（< 30天）和5年相对生存率由社会经济状况进行评估，根据2006年苏格兰多发性痴呆指数进行评估，不同社会经济群体之间的年龄、性别或肿瘤特征没有差异。与最富裕的群体相比，来自最贫困群体的患者更有可能出现紧急情况（23.5 vs 19.5%; p = 0.033），接受姑息手术（20.0 vs 14.5%; p <0.001），具有更高水平的合并症（p = .03），检查淋巴结< 12个（56.7 vs 53.1%; p = .016），但更有可能在专科外科医生的护理下接受手术（76.3 vs 72.0%; p = .001）。在多变量分析中，剥夺与术后死亡率增加独立相关[调整后优势比2.26（95%CI，1.45-3.53; p <0.001）]和较差的5年相对生存率[校正相对超额风险（RER）1.25（95% CI，1.03-1.51; p = .024）]，但排除术后死亡后未发生[调整后的RER 1.08（95%，CI .87-1.34; p = .472）]。结直肠癌手术后的长期存活率是由于更贫困群体的早期术后死亡率更高。
Deprivation is associated with poorer survival after surgery for colorectal cancer, but determinants of this socioeconomic inequality are poorly understood.A total of 4,296 patients undergoing surgery for colorectal cancer in 16 hospitals in the West of Scotland between 2001 and 2004 were identified from a prospectively maintained regional audit database. Postoperative mortality (< 30 days) and 5-year relative survival by socioeconomic circumstances, measured by the area-based Scottish Index of Multiple Deprivation 2006, were examined.There was no difference in age, gender, or tumor characteristics between socioeconomic groups. Compared with the most affluent group, patients from the most deprived group were more likely to present as an emergency (23.5 vs 19.5 %; p = .033), undergo palliative surgery (20.0 vs 14.5 %; p < .001), have higher levels of comorbidity (p = .03), have < 12 lymph nodes examined (56.7 vs 53.1 %; p = .016) but were more likely to receive surgery under the care of a specialist surgeon (76.3 vs 72.0 %; p = .001). In multivariate analysis, deprivation was independently associated with increased postoperative mortality [adjusted odds ratio 2.26 (95 % CI, 1.45-3.53; p < .001)], and poorer 5-year relative survival [adjusted relative excess risk (RER) 1.25 (95 % CI, 1.03-1.51; p = .024)] but not after exclusion of postoperative deaths [adjusted RER 1.08 (95 %, CI .87-1.34; p = .472)].The observed socioeconomic gradient in long-term survival after surgery for colorectal cancer was due to higher early postoperative mortality among more deprived groups.