Survival of indigenous and non-indigenous Queenslanders after a diagnosis of lung cancer: a matched cohort study
Survival of indigenous and non-indigenous Queenslanders after a diagnosis of lung cancer: a matched cohort study
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DOI：
10.5694/j.1326-5377.2008.tb01790.x
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发表时间：
2008-05-19
影响因子：
11.4
通讯作者：
Valery, Patricia C.
中科院分区：
文献类型：
--
作者：
Coory, Michael D.;Green, Adele C.;Valery, Patricia C.
目的：比较土著人和非土著人肺癌患者的生存率，并研究在分期、治疗和合并症方面的任何相应差异。设计和设置：158名土著人和152名非土著人患者的队列研究1996年至2002年期间诊断为肺癌并在昆士兰州公立医院接受治疗的患者（在年龄、性别和农村性方面频率匹配）。肺癌诊断后的生存率;诊断时的分期、治疗、合并症和组织学亚型对肺癌特异性生存率的影响。结果：土著肺癌患者的生存率显著低于非土著患者（中位生存期，4.3 vs 10.3个月;风险比，1.48; 95% CI，1.14-1.92）。在158例土著患者中，72例（46%）接受了化疗、放疗或手术的积极治疗，而152例非土著患者中有109例（72%）接受了化疗、放疗或手术的积极治疗，在调整了组织学亚型、诊断分期和合并症后，这种治疗差异仍然存在（调整后的风险比，0.65; 95%CI，0.53-0.73）。治疗差异解释了大部分生存缺陷：在比例风险生存模型中纳入治疗变量后，风险比降至1.10（95% CI，0.83-1.44）。其余的生存赤字解释土著癌症患者，主要是diabetes.Conclusion：诊断肺癌后的生存土著患者比非土著患者更差，两组之间的治疗差异是主要负责的。
Objective: To compare survival of Indigenous and non-Indigenous lung cancer patients and to investigate any corresponding differences in stage, treatment and comorbidities.Design and setting: Cohort study of 158 Indigenous and 152 non-indigenous patients (frequency-matched on age, sex and rurality) diagnosed with lung cancer between 1996 and 2002 and treated in Queensland public hospitals.Main outcome measures: Survival after diagnosis of lung cancer; effects of stage at diagnosis, treatment, comorbidities and histological subtype on lung cancer-specific survival.Results: Survival of Indigenous lung cancer patients was significantly lower than that of non-Indigenous patients (median survival, 4.3 v 10.3 months; hazard ratio, 1.48; 95% CI, 1.14-1.92). Of 158 Indigenous patients, 72 (46%) received active treatment with chemotherapy, radiotherapy or surgery compared with 109 (72%) of the 152 non-Indigenous patients, and this treatment disparity remained after adjusting for histological subtype, stage at diagnosis, and comorbiclities (adjusted risk ratio, 0.65; 95% CI, 0.53-0.73). The treatment disparity explained most of the survival deficit: the hazard ratio reduced to 1.10 (95% CI, 0.83-1.44) after inclusion of treatment variables in the proportional hazards survival model. The remaining survival deficit was explained by the higher prevalence of comorbiclities among Indigenous cancer patients, mainly diabetes.Conclusion: Survival after a diagnosis of lung cancer is worse for Indigenous patients than for non-Indigenous patients, and differences in treatment between the two groups are mainly responsible.