Socioeconomic factors and survival in patients with non-metastatic head and neck squamous cell carcinoma.
Socioeconomic factors and survival in patients with non-metastatic head and neck squamous cell carcinoma.
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非转移性头颈鳞状细胞癌患者的社会经济因素和生存率
DOI：
10.1111/cas.13250
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发表时间：
2017-06
期刊：
影响因子：
5.7
通讯作者：
Ma J
中科院分区：
文献类型：
--
作者：
Xu C;Chen YP;Liu X;Tang LL;Chen L;Mao YP;Zhang Y;Guo R;Zhou GQ;Li WF;Lin AH;Sun Y;Ma J
社会经济因素对非转移性头颈部鳞状细胞癌（HNSCC）接受确定性治疗和生存结局的影响尚不清楚。从2007年至2012年的美国监测、流行病学和最终结果（SEER）数据库中确定了合格患者（n = 37 995）。社会经济因素（即，中位家庭收入、教育水平、失业率、保险状况、婚姻状况和居住地）纳入单变量/多变量考克斯回归分析;使用验证的因素生成原因特异性生存（CSS）和总生存（OS）的列线图，以及风险分层的预后评分模型。比较了所有癌症子中心的低风险和高风险组。在每个风险组中研究了人种/种族对生存期的影响。婚姻状况、家庭收入中位数和保险状况被纳入CSS和OS的列线图中，其c指数高于第6版TNM分期系统（均P < 0.001）。基于三个不利的社会经济因素（即，未婚状态、无保险状态、家庭收入中位数<65 394美元），预后评分模型生成了评分为0、1、2或3的四个风险亚组，其CSS/OS曲线显着分离（所有P < 0.001）。低风险患者（评分0-1）比高风险患者（评分2-3）更有可能接受明确治疗并获得更好的CSS/OS。具有高风险社会经济地位的中国和非西班牙裔黑人患者的CSS/OS分别最好和最差。因此，婚姻状况、家庭收入中位数和保险状况对预测生存结局具有重要意义。低风险社会经济地位和中国人种/种族在HNSCC中具有保护作用。
The effect of socioeconomic factors on receipt of definitive treatment and survival outcomes in non‐metastatic head and neck squamous cell carcinoma (HNSCC) remains unclear. Eligible patients (n = 37 995) were identified from the United States Surveillance, Epidemiology and End Results (SEER) database between 2007 and 2012. Socioeconomic factors (i.e., median household income, education level, unemployment rate, insurance status, marital status and residence) were included in univariate/multivariate Cox regression analysis; validated factors were used to generate nomograms for cause‐specific survival (CSS) and overall survival (OS), and a prognostic score model for risk stratification. Low‐ and high‐risk groups were compared for all cancer subsites. Impact of race/ethnicity on survival was investigated in each risk group. Marital status, median household income and insurance status were included in the nomograms for CSS and OS, which had higher c‐indexes than the 6th edition TNM staging system (all P < 0.001). Based on three disadvantageous socioeconomic factors (i.e., unmarried status, uninsured status, median household income <US $65 394), the prognostic score model generated four risk subgroups with scores of 0, 1, 2 or 3, which had significantly separated CSS/OS curves (all P < 0.001). Low‐risk patients (score 0–1) were more likely to receive definitive treatment and obtain better CSS/OS than high‐risk patients (score 2–3). Chinese and non‐Hispanic black patients with high‐risk socioeconomic status had best and poorest CSS/OS, respectively. Therefore, marital status, median household income and insurance status have significance for predicting survival outcomes. Low‐risk socioeconomic status and Chinese race/ethnicity confer protective effects in HNSCC.