Understanding disparities in leukemia: a national study
Understanding disparities in leukemia: a national study
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DOI：
10.1007/s10552-012-0062-3
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发表时间：
2012-11-01
影响因子：
2.3
通讯作者：
Rhoads, K. F.
中科院分区：
文献类型：
--
作者：
Patel, M. I.;Ma, Y.;Rhoads, K. F.
实体瘤的差异已得到充分研究。然而，在基于人群的水平上，血液恶性肿瘤的差异相对尚未得到探索。本研究的目的是探讨人种/族裔与急性白血病死亡率之间的关系。1999-2008 年监测流行病学和最终结果数据库中确定了所有急性白血病 [急性淋巴细胞白血病 (ALL) 和急性髓性白血病 (AML)] 患者。生成卡普兰-迈耶曲线以反映种族/民族的生存概率。多变量 Cox 比例风险模型通过对个体（年龄、性别、诊断年份）和选择的遗传因素进行调整，估计了种族的死亡风险。该研究总共纳入了 39,002 名急性白血病患者。总体而言，与非西班牙裔白人相比，黑人（HR 1.17，p < 0.0001）和西班牙裔（HR 1.13，p < 0.0001）的急性白血病死亡率存在差异。在分层分析中，ALL 的差异大于 AML；黑人（HR[ALL]1.45，p < 0.0001；HR[AML]1.12，p < 0.0011）；西班牙裔（HR[ALL]1.46，p < 0.0001；HR[AML]1.06，p < 0.0001）。对个体患者和选择的遗传因素进行调整并不能解释差异。与其他人相比，黑人和西班牙裔患急性白血病的生存率较低。需要进一步调查来了解这些人群癌症结果不佳的驱动因素。
Disparities in solid tumors have been well studied. However, disparities in hematologic malignancies have been relatively unexplored on population-based levels. The purpose of this study is to examine the relationship between race/ethnicity and acute leukemia mortality.All patients with acute leukemia [acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML)] were identified in the Surveillance Epidemiology and End Results database, 1999-2008. Kaplan-Meier curves were generated to reflect survival probabilities by race/ethnicity. Multivariable Cox proportional hazard models estimated hazard of mortality by race with adjustment for individual (age, gender, year of diagnosis) and select genetic factors.A total of 39,002 patients with acute leukemia were included in the study. Overall, there was a mortality disparity in acute leukemia for blacks (HR 1.17, p < 0.0001) and Hispanics (HR 1.13, p < 0.0001) compared with non-Hispanic whites. In stratified analysis, disparities in ALL were greater than AML; blacks (HR[ALL]1.45, p < 0.0001; HR[AML]1.12, p < 0.0011); Hispanics (HR[ALL]1.46, p < 0.0001; HR[AML]1.06, p < 0.0001). Adjustment for individual patient and select genetic factors did not explain disparities.Blacks and Hispanics suffer decreased survival in acute leukemia as compared to others. Further investigation is needed to understand the drivers of poor cancer outcomes in these populations.