The impact of gender, race, socioeconomic status, and treatment on outcomes in esophageal cancer: A population-based analysis.
The impact of gender, race, socioeconomic status, and treatment on outcomes in esophageal cancer: A population-based analysis.
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DOI：
10.4103/jcar.jcar_4_17
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发表时间：
2017
影响因子：
--
通讯作者：
Zell JA
中科院分区：
文献类型：
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作者：
Tran PN;Taylor TH;Klempner SJ;Zell JA
据报道，非裔美国人和西班牙裔食管癌（EC）的死亡率高于白人。在这项研究中，我们分析了种族、性别、治疗和社会经济地位（SES）对总生存期（OS）的独立影响。从加州癌症登记处获得了2004年至2010年随访至2012年的所有EC病例的数据。我们采用Kaplan-Meier和考克斯比例风险法对临床变量和生存率进行描述性分析。在该队列中，非洲裔美国人和西班牙裔美国人更有可能处于较低的SES层，并且接受手术的可能性低于白人。不同人种/种族组接受化疗和放疗的患者比例相似。在多变量分析中调整了分期、分级、组织学、治疗和SES后，（风险比[HR] 0.96，95%置信区间[CI] 0.85-1.07）和西班牙裔（HR 0.96，95% CI 0.89-1.07）与白人（HR = 1.00，参照）无差异，组织学、SES和手术在很大程度上解释了未校正的OS差异。我们还观察到，非洲裔美国男性的校正死亡风险高于白人男性（HR 1.24，95% CI 1.07-1.42），但非洲裔美国女性的校正死亡风险高于白人女性（HR 1.12，95% CI 0.94-1.35）。在我们基于人群的EC病例分析中，种族不是OS的独立风险因素。相反，观察到的不同人种/种族的OS差异是由于癌症组织学、SES、手术和性别的差异所致。我们的研究结果支持对这种疾病的进一步健康差异研究。
African Americans and Hispanics are reported to have higher mortality from esophageal cancer (EC) than Caucasians. In this study, we analyzed the independent effects of race, gender, treatment, and socioeconomic status (SES) on overall survival (OS). Data for all EC cases between 2004 and 2010 with follow-up through 2012 were obtained from the California Cancer Registry. We conducted descriptive analyses of clinical variables and survival analyses by Kaplan–Meier and Cox proportional hazards methods. African Americans and Hispanics were more likely to be in the lower SES strata and less likely to receive surgery than Caucasians in this cohort. The proportion of patients receiving chemotherapy and radiotherapy was similar across different racial/ethnic groups. After adjustment for stage, grade, histology, treatments, and SES in multivariate analyses, the mortality risk in African Americans (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.85–1.07) and Hispanics (HR 0.96, 95% CI 0.89–1.07) did not differ from Caucasians (HR = 1.00, referent), with histology, SES, and surgery largely accounting for unadjusted OS differences. We also observed that African American men had higher adjusted risk of death relative to Caucasian men (HR 1.24, 95% CI 1.07–1.42), but this effect was not observed for African American women compared to Caucasian women (HR 1.12, 95% CI 0.94–1.35). Race is not an independent risk factor for OS in our population-based analysis of EC cases. Rather, observed differences in OS by race/ethnicity result from differences in cancer histology, SES, surgery, and gender. Our findings support further health disparities research for this disease.