Racial disparity and their impact on hepatocellular cancer outcomes in inner-city New Orleans
Racial disparity and their impact on hepatocellular cancer outcomes in inner-city New Orleans
复制标题
DOI：
10.1016/j.surg.2012.07.008
复制
发表时间：
2012-10-01
期刊：
影响因子：
3.8
通讯作者：
Buell, Joseph F.
中科院分区：
文献类型：
--
作者：
Jan, Thomas;Medvedev, Sabeen;Buell, Joseph F.
背景。影响生存的社会经济因素的作用，特别是对肝细胞癌（HCC），尚未得到充分的分析。本研究试图阐明影响hcc患者生存差异的种族和社会经济因素。在一项回顾性队列研究中，2003年至2011年在市中心诊断为HCC的206例患者，按种族（非裔美国人与白人）分析了结果。对社会经济因素给予了额外的注意。连续变量采用Student t检验，分类变量采用chi(2)或Fisher精确检验。采用logistic回归模型进行多因素分析。采用Kaplan-Meier和Cox比例风险对患者死亡和生存数据进行分析。138例白人患者和68例非裔美国人患者的比较显示，非裔美国患者在诊断时更可能出现较大的肿瘤大小（4.7 vs 3.7 cm; P < 0.05）。非裔美国患者静脉注射吸毒者（25.4%比11.6%,P < 0.05）和丙型肝炎肝硬化（81%比60%，P < 0.01）的可能性也更大。与白人患者相比，非裔美国患者较少有私人保险（68% vs 92%; P < 0.01）。尽管我们在市中心的实践中发现了这些结果，但两组之间的肝移植率和存活率没有差异。尽管非裔美国患者表现出较差的肿瘤特征，但在针对其特定人群所面临的挑战进行治疗的方案中，非裔美国患者能够达到与白人患者相当的生存率。(手术,2012;152:661-7)。
Background. The role of socioeconomic factors that affect survival, particularly for hepatocellular cancer (HCC), has yet to be fully analyzed. This study attempts to elucidate those racial and socioeconomic factors that affect differences in survival for patients with HCC.Methods. In a retrospective cohort study of 206 patients with HCC diagnosed in an inner-city urban center from 2003 to 2011, outcomes by race (African Americans versus white) were analyzed. Additional attention was paid to socioeconomic factors. Continuous variables were compared with the Student t-test, and categorical variables were compared with the chi(2) or Fisher exact test. Multivariate analysis was conducted using a logistic regression model. Patient death and survival data were analyzed with Kaplan-Meier and Cox proportional hazards.Results. Comparison of 138 white and 68 African-American patients revealed that African-American patients were, more likely to present with larger tumor size at the time of diagnosis (4.7 vs 3.7 cm; P < .05). African-American patients were also more likely to be intravenous drug users (25.4% vs 11.6%; P < .05) and have cirrhosis from hepatitis C (81% vs 60%; P < .01). African-American patients were less likely to have private insurance compared with white patients (68% vs 92%; P < .01). Despite these findings in our inner-city practice, there was no difference in liver transplantation rates or survival rates between the 2 groups.Conclusion. Despite presentation with less-favorable tumor characteristics, African-American patients are able to achieve survival that is comparable with their white counterparts when treated in a program that is attuned to the challenges faced by their specific population. (Surgery, 2012;152:661-7.)