种族和种族差异，用于进入直肠癌的全新辅助治疗
Racial and ethnic disparities in access to total neoadjuvant therapy for rectal cancer
影响因子:2.70000
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
摘要
Neoadjuvant的全部疗法已彻底改变了局部晚期直肠癌的治疗，并迅速成为新的护理标准。但是，来自所有种族和族裔的患者是否能够平等获得这些潜在益处。但是，我们确定了加利福尼亚州诊断出的所有被诊断为局部晚期直肠癌的成年人，他们使用加利福尼亚癌症注册表从2010年到2020年接受了新辅助化学疗法和辐射。我们使用逻辑回归来估计接受全新的新辅助治疗的预测概率，而不是为每个种族和种族群体进行传统的化学疗法，并使用时间范围的相互作用来评估随着时间的推移获得全新辅助治疗的趋势。我们还使用Kaplan-Meier地块和Cox比例危害模型比较了种族和种族的生存以及NeoAdjuvant总治疗状态。在总共6,856名患者符合纳入标准中。总体而言，2010年的36.6％的患者接受了全新的新辅助治疗，而2020年为66.3％。拉丁裔患者接受了全新的新辅助治疗的可能性明显少得多。但是，随着时间的流逝，种族和族裔群体之间的新辅助治疗的增长率没有差异。与非拉丁裔白人患者相比，非拉丁裔黑人患者的风险调整后的生存率似乎较低，尽管在接受Neoadjuvant疗法的总患者中，对加利福尼亚州的Neoadjuvant总疗法的访问却没有显着增加，而种族和族裔群体之间的增长率没有明显的差异。我们没有发现接受全新辅助治疗治疗的患者中种族或种族差异的证据，这表明增加获得高质量的癌症护理的机会也可以改善健康公平。
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.