Racial/Ethnic Disparities in Access to Care and Survival for Patients With Early-Stage Hepatocellular Carcinoma
Racial/Ethnic Disparities in Access to Care and Survival for Patients With Early-Stage Hepatocellular Carcinoma
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DOI：
10.1001/archsurg.2010.272
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发表时间：
2010-12-01
影响因子：
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通讯作者：
Sonnenday, Christopher J.
中科院分区：
文献类型：
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作者：
Mathur, Amit K.;Osborne, Nicholas H.;Sonnenday, Christopher J.
目的：确定早期肝细胞癌(HCC)患者在使用侵入性治疗时是否存在种族/民族差异。设计：一项利用监测、流行病学和最终结果(SEER)资料进行的回顾性队列研究。侵入性治疗被定义为肿瘤切除、肝切除或肝移植。种族/民族被定义为白人、黑人、亚洲人、西班牙人或其他人。使用Kaplan-Meier方法和基础和治疗分层多变量COX比例风险模型评估总体和治疗调整后生存率的种族/民族差异。患者：1995年1月1日至2006年12月31日期间所有被诊断为I期或II期肝癌的患者(N=13 244)。地点：数据来自国家癌症研究所的SEER登记。主要观察指标：考虑到使用侵入性治疗和治疗益处，不同种族/民族的生存率差异。结果：总体而言，32.8%的患者接受了侵入性治疗。我们发现，在基本生存模型中，黑人(风险比[HR]，1.24；95%可信区间[CI]，1.15-1.33)和西班牙裔(1.08；1.01-1.15)患者的死亡率较高，而亚洲患者的死亡率(0.87；0.82-0.93)低于白人。分层治疗后，黑人死亡率比白人高12%(HR，1.11；95%CI，1.03-1.20)，西班牙裔死亡率(0.97；0.91-1.04)相似，亚裔死亡率(0.84；0.79-0.89)低16%。结论：在早期肝癌患者中，少数族裔和白人患者之间的生存存在显著的种族/民族差异。在考虑了阶段、侵入性治疗的使用和治疗益处的差异后，拉美裔和白人之间没有明显的种族/民族生存差异，但黑人的存活率一直很低。
Objective: To determine whether controlling for differences in the use of invasive therapy affects racial/ethnic differences in survival of early-stage hepatocellular carcinoma (HCC).Design: A retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) HCC data. Invasive therapy was defined as tumor ablation, hepatectomy, or liver transplant. Race/ethnicity was defined as white, black, Asian, Hispanic, or other. Racial/ethnic differences in overall and treatment-adjusted survival were assessed using the Kaplan-Meier method and base-and treatment-stratified multivariable Cox proportional hazards models.Patients: All patients diagnosed as having stage I or II HCC from January 1, 1995, through December 31, 2006 (N = 13 244).Setting: Data were obtained from the National Cancer Institute's SEER registry.Main Outcome Measures: Differences in survival by race/ethnicity accounting for the use of invasive therapy and treatment benefit.Results: Overall, 32.8% of patients received invasive therapy. We found higher mortality rates in the base survival model for black (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.15-1.33) and Hispanic (1.08; 1.01-1.15) patients and lower mortality rates in Asian patients (0.87; 0.82-0.93) compared with whites. After treatment stratification, compared with white patients, blacks had a 12% higher mortality rate (HR, 1.11; 95% CI, 1.03-1.20), Hispanics had a similar mortality rate (0.97; 0.91-1.04), and Asians had a 16% lower mortality rate (0.84; 0.79-0.89).Conclusions: For early-stage HCC, racial/ethnic disparities in survival between minority and white patients are notable. After accounting for differences in stage, use of invasive therapy, and treatment benefit, no racial/ethnic survival disparity is evident between Hispanics and whites, but blacks have persistently poor survival.