Geographical disparities in the prognosis of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: a large institution-based cohort study from an endemic area.
Geographical disparities in the prognosis of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: a large institution-based cohort study from an endemic area.
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接受调强放射治疗的鼻咽癌患者预后的地理差异：来自流行地区的大型机构队列研究
DOI：
10.1136/bmjopen-2020-037150
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发表时间：
2020-11-10
期刊：
影响因子：
2.9
通讯作者：
Sun R
中科院分区：
文献类型：
--
作者：
Lin ST;Meng DF;Yang Q;Wang W;Peng LX;Zheng LS;Qiang YY;Mei Y;Xu L;Li CZ;Peng XS;Hu H;Lang YH;Liu ZJ;Wang MD;Li HF;Huang BJ;Qian CN;Sun R
地理差异已被确定为癌症筛查的一个特定障碍，也是癌症患者预后不良的原因。在本研究中，我们的目的是评估地理差异对鼻咽癌（NPC）患者接受调强放射治疗（IMRT）的生存结局的影响。队列研究。中国广州。从2010年1月1日至2014年12月31日，共有1002例成年NPC患者（724例男性和278例女性）按居住地区（农村或城市）分类，在中山大学肿瘤防治中心接受调强放疗。在倾向评分匹配（PSM）后，812例患者仍在分析中。我们使用PSM来减少与治疗效果和结局预测相关的变量的偏倚。使用Kaplan-Meier方法估计生存结局，并通过对数秩检验进行比较。多因素考克斯回归分析用于确定独立的预后因素。在匹配队列中，812例患者仍在分析中。Kaplan-Meier生存分析显示，农村组的总生存率（OS，p<0.001）、无病生存率（DFS，p<0.001）、局部无复发生存率（LRRFS，p=0.003）和无远处转移生存率（DMFS，p<0.001）显著相关。多变量考克斯回归显示OS较差（HR=3.126; 95% CI 1.902至5.138; p<0.001），DFS（HR=2.579; 95% CI 1.815 - 3.665; p<0.001），LRRFS（HR=2.742; 95% CI 1.359 - 5.533; p=0.005）和DMFS（HR=2.461; 95% CI 1.574 - 3.850; p<0.001）。接受相同标准化治疗的NPC患者的生存结局在城市地区明显优于农村地区。通过分析NPC结果的地理差异，我们可以指导医疗政策的制定。
Geographical disparities have been identified as a specific barrier to cancer screening and a cause of worse outcomes for patients with cancer. In the present study, our aim was to assess the influence of geographical disparities on the survival outcomes of patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). Cohort study. Guangzhou, China. A total of 1002 adult patients with NPC (724 males and 278 females) who were classified by area of residence (rural or urban) received IMRT from 1 January 2010 to 31 December 2014, at Sun Yat-sen University Cancer Center. Following propensity score matching (PSM), 812 patients remained in the analysis. We used PSM to reduce the bias of variables associated with treatment effects and outcome prediction. Survival outcomes were estimated using the Kaplan-Meier method and compared by the log-rank test. Multivariate Cox regression was used to identify independent prognostic factors. In the matched cohort, 812 patients remained in the analysis. Kaplan-Meier survival analysis revealed that the rural group was significantly associated with worse overall survival (OS, p<0.001), disease-free survival (DFS, p<0.001), locoregional relapse-free survival (LRRFS, p=0.003) and distant metastasis-free survival (DMFS, p<0.001). Multivariate Cox regression showed worse OS (HR=3.126; 95% CI 1.902 to 5.138; p<0.001), DFS (HR=2.579; 95% CI 1.815 to 3.665; p<0.001), LRRFS (HR=2.742; 95% CI 1.359 to 5.533; p=0.005) and DMFS (HR=2.461; 95% CI 1.574 to 3.850; p<0.001) for patients residing in rural areas. The survival outcomes of patients with NPC who received the same standardised treatment were significantly better in urban regions than in rural regions. By analysing the geographic disparities in outcomes for NPC, we can guide the formulation of healthcare policies.
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