种族与民族在直肠癌全新辅助治疗中的差异

Racial and ethnic disparities in access to total neoadjuvant therapy for rectal cancer

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SURGERY

影响因子:2.7

分区:医学2区 / 外科2区

发表日期:2024 Oct

作者: Michelle Chan, Ganesh Rajasekar, Katherine D Arnow, Todd H Wagner, Aaron J Dawes

DOI: 10.1016/j.surg.2024.06.022

摘要

全新辅助治疗已彻底改变局部晚期直肠癌的治疗方式，并迅速成为新的治疗标准。然而，来自不同种族和民族患者是否有平等获取这些潜在益处的机会，仍然未知。我们利用加利福尼亚癌症登记处，识别了2010年至2020年间在加利福尼亚确诊为局部晚期直肠癌并接受新辅助化疗与放疗的所有成人患者。我们采用逻辑回归模型估算每个种族和民族群体接受全新辅助治疗（而非传统的化疗放疗联合治疗）的预测概率，并使用时间-种族交互作用评估随时间变化的全新辅助治疗的获取趋势。我们还通过Kaplan-Meier曲线和Cox比例风险模型比较了不同种族和民族群体以及全新辅助治疗状态下的生存情况。共有6,856名患者符合纳入标准。整体而言，2010年有36.6%的患者接受了全新辅助治疗，而到2020年这一比例升至66.3%。拉丁裔患者接受全新辅助治疗的可能性显著低于非拉丁裔白人患者；然而，不同种族和民族群体在全新辅助治疗增长率方面没有差异。非拉丁裔黑人患者的风险调整后生存率似乎低于非拉丁裔白人患者，尽管在接受全新辅助治疗的患者中没有这种差异。加利福尼亚州的全新辅助治疗获取率随着时间显著提高，不同种族和民族群体之间的增长速度无明显差异。在接受全新辅助治疗的患者中，生存差异不存在证据，这表明增加优质癌症护理的可及性也可能改善健康公平性。

Abstract

Total neoadjuvant therapy has revolutionized the treatment of locally advanced rectal cancer and quickly become the new standard of care. Whether patients from all racial and ethnic groups have had equal access to these potential benefits, however, remains unknown.We identified all adults diagnosed with locally advanced rectal cancer in California who underwent neoadjuvant chemotherapy and radiation from 2010 to 2020 using the California Cancer Registry. We used logistic regression to estimate the predicted probability of receiving total neoadjuvant therapy as opposed to traditional chemoradiotherapy for each racial and ethnic group and used a time-race interaction to evaluate trends in access to total neoadjuvant therapy over time. We also compared survival by racial and ethnic group and total neoadjuvant therapy status using Kaplan-Meier plots and Cox proportional hazards models.In total, 6,856 patients met inclusion criteria. Overall, 36.6% of patients received total neoadjuvant therapy in 2010 compared with 66.3% in 2020. Latino patients were significantly less likely than non-Latino White patients to undergo total neoadjuvant therapy ; however, there was no difference in the rate of growth in total neoadjuvant therapy over time between racial and ethnic groups. Non-Latino Black patients appeared to have lower risk-adjusted survival compared with non-Latino White patients, although not among patients who underwent total neoadjuvant therapy .Access to total neoadjuvant therapy has increased significantly over time in California with no apparent difference in the rate of growth between racial and ethnic groups. We found no evidence of racial or ethnic disparities in survival among patients treated with total neoadjuvant therapy, suggesting that increasing access to high-quality cancer care may also improve health equity.