美国成人眼部黑色素瘤的社会脆弱性评估及预后分析

Assessment of Social Vulnerabilities of Care and Prognosis in Adult Ocular Melanomas in the US

ANNALS OF SURGICAL ONCOLOGY

影响因子:3.5

分区:医学2区 / 外科2区肿瘤学3区

发表日期:2024 May

作者: Joshua A Mensah, David J Fei-Zhang, Jennifer L Rossen, Bahram Rahmani, David J Bentrem, Joshua D Stein, Dustin D French

DOI: 10.1245/s10434-024-15038-w

摘要

以往研究关注社会决定因素对多种癌症的影响，但对眼部或眼眶癌的分析较少。现有文献多集中在社会经济地位和种族上，少涉及多学科贡献的全面评估。我们采用美国疾病控制与预防中心（CDC）社会脆弱指数（SVI）衡量社会决定因素，量化美国范围内眼部及眼眶黑色素瘤的差异。回顾性分析了1975年至2017年使用SEER数据库诊断的15,157例眼部或眼眶癌患者，其中提取6139例眼部黑色素瘤样本。抽取SVI评分并与患者资料匹配，评分基于县级普查区的人口密度加权平均值。主要结局指标为存活月数，次要指标包括晚期分期、高级别肿瘤及首次手术接受情况。随着SVI总分升高，显示出黑色素瘤组织学的存活时间下降了23.1%（p<0.001），以及在主要部位的存活时间下降19.6%-39.7%。SVI升高与高分级（比值比[OR] 1.20，95%置信区间[CI] 1.02-1.43）相关，且接受手术的可能性降低（OR 0.94，95% CI 0.92-0.96）。在四个主题中，社会经济状态（贡献26.0%）和住房交通（贡献14.4%）的影响最大，而少数族裔语言（13.5%）和家庭结构（9.0%）影响较小。社会脆弱性增加，依据CDC SVI及其子项的评分，与成人眼部黑色素瘤的预后和治疗因素均呈现显著不良趋势。子项评分明确了哪些社会决定因素对差异贡献最大，为临床提供了针对性干预的潜在目标。

Abstract

Prior works have studied the impact of social determinants on various cancers but there is limited analysis on eye-orbit cancers. Current literature tends to focus on socioeconomic status and race, with sparse analysis of interdisciplinary contributions. We examined social determinants as measured by the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), quantifying eye and orbit melanoma disparities across the United States.A retrospective review of 15,157 patients diagnosed with eye-orbit cancers in the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2017 was performed, extracting 6139 ocular melanomas. SVI scores were abstracted and matched to SEER patient data, with scores generated by weighted averages per population density of county's census tracts. Primary outcome was months survived, while secondary outcomes were advanced staging, high grading, and primary surgery receipt.With increased total SVI score, indicating more vulnerability, we observed significant decreases of 23.1% in months survival for melanoma histology (p < 0.001) and 19.6-39.7% by primary site. Increasing total SVI showed increased odds of higher grading (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.02-1.43) and decreased odds of surgical intervention (OR 0.94, 95% CI 0.92-0.96). Of the four themes, higher magnitude contributions were observed with socioeconomic status (26.0%) and housing transportation (14.4%), while lesser magnitude contributions were observed with minority language status (13.5%) and household composition (9.0%).Increasing social vulnerability, as measured by the CDC SVI and its subscores, displayed significant detrimental trends in prognostic and treatment factors for adult eye-orbit melanoma. Subscores quantified which social determinants contributed most to disparities. This lays groundwork for providers to target the highest-impact social determinant for non-clinical factors in patient care.