Decreased Use of Sphincter-Preserving Procedures Among African Americans with Rectal Cancer
Decreased Use of Sphincter-Preserving Procedures Among African Americans with Rectal Cancer
复制标题
DOI：
10.1245/s10434-017-6306-4
复制
发表时间：
2018-03-01
影响因子：
3.7
通讯作者：
Kwaan, Mary R.
中科院分区：
文献类型：
--
作者：
Arsoniadis, Elliot G.;Fan, Yunhua;Kwaan, Mary R.
直肠癌多模式治疗的改进增加了保肛手术的使用。本研究旨在确定非裔美国人（AA）直肠癌患者接受保肛手术的比率是否与非AA患者相同。本研究使用1998-2012年的全国住院患者样本，比较AA和非AA直肠癌患者接受低位前切除术或腹会阴切除术。采用logistic回归模型校正年龄、性别、入院类型、Elixhauser合并症指数和医院因素，如规模、位置（城市与农村）、教学状况和手术量。检索确定了22,697例患者，其中1600例被确定为AA。调整年龄和性别后，分析显示AA患者比非AA患者更不可能接受保肛手术[比值比（OR）0.70; 95%置信区间（CI）0.63-0.78; p < 0.0001]。在进一步调整Elixhauser合并症指数、入院类型、医院特异性因素和保险状况后，分析显示AA患者仍然不太可能接受保肛手术（OR 0.78; 95%CI 0.70-0.87; p < 0.0001）。虽然在研究期间非AA患者接受保肛手术的比例增加（p = 0.0003），但这一趋势对AA患者并不显著（p = 0.13）。在该数据分析中，AA直肠癌患者的保肛手术率低于非AA患者，即使调整了患者和医院的特定因素。需要进一步的工作来阐明原因。消除直肠癌治疗中的种族差异应继续成为外科界的优先事项。
Improved multimodality rectal cancer treatment has increased the use of sphincter-preserving surgery. This study sought to determine whether African American (AA) patients with rectal cancer receive sphincter-preserving surgery at the same rate as non-AA patients.The study used the Nationwide Inpatient Sample for years 1998-2012 to compare AA and non-AA patients with rectal cancer undergoing low anterior resection or abdominoperineal resection. The logistic regression model was used to adjust for age, gender, admission type, Elixhauser comorbidity index, and hospital factors such as size, location (urban vs.rural), teaching status, and procedure volume.The search identified 22,697 patients, 1600 of whom were identified as AA. After adjustment for age and gender, the analysis showed that AA patients were less likely to undergo sphincter-preserving surgery than non-AA patients [odds ratio (OR) 0.70; 95% confidence interval (CI) 0.63-0.78; p < 0.0001). After further adjustment for the Elixhauser comorbidity index, admission type, hospital-specific factors, and insurance status, the analysis showed that AA patients still were less likely to undergo sphincter-preserving surgery (OR 0.78; 95% CI 0.70-0.87; p < 0.0001). Although the proportion of non-AA patients undergoing sphincter-preserving surgery increased during the study period (p = 0.0003), this trend was not significant for the AA patients (p = 0.13).In this data analysis, the AA patients with rectal cancer had lower rates of sphincter-preserving surgery than the non-AA patients, even after adjustment for patient- and hospital-specific factors. Further work is required to elucidate why. Eliminating racial disparities in rectal cancer treatment should continue to be a priority for the surgical community.