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Abstract：
OBJECTIVE: Socioeconomic status (SES) is often used to quantify social determinants of health. This study uses the National Cancer Institute SES index to examine the effect of SES on disease-specific survival and 5-year conditional disease-specific survival (CDSS; the change in life expectancy with increasing survivorship) in paranasal sinus cancer.
METHODS: Cross-sectional analysis.
METHODS: National Cancer Institute\'s Surveillance, Epidemiology and End Results (SEER) program.
METHODS: A study of adults with sinus cancer between 1973 and 2015 was performed. The Yost index, a census tract-level composite score of SES, was used to categorize patients. Kaplan-Meier analysis and Cox regression for disease-specific survival were stratified by SES. CDSS was calculated with simplified models. Logistic regression was conducted to identify risk factors for advanced stage at diagnosis, multimodal therapy, and diagnosis of squamous cell carcinoma.
RESULTS: There were 3437 patients analyzed. In Cox models adjusting for patient-specific factors, the lowest SES tertile exhibited worse mortality (hazard ratio, 1.22; 95% CI, 1.07-1.39; P < .01). After addition of treatment and pathology, SES was not significant (P = .07). The lowest SES tertile was more often diagnosed at later stages (odds ratio [OR], 1.52; 95% CI, 1.12-2.06; P < .01). For those with regional/distant disease, the middle tertile (OR, 0.75; 95% CI, 0.63-0.90; P < .01) and lowest tertile (OR, 0.75; 95% CI, 0.62-0.91; P < .01) were less likely to receive multimodal therapy. SES tertiles primarily affected 5-year CDSS for regional/distant disease. CDSS for all stages converged over time.
CONCLUSIONS: Lower SES is associated with worse outcomes in paranasal sinus cancer. Research should be devoted toward understanding factors that contribute to such disparities, including tumor pathology and treatment course.
METHODS: Cross-sectional analysis.
METHODS: National Cancer Institute\'s Surveillance, Epidemiology and End Results (SEER) program.
METHODS: A study of adults with sinus cancer between 1973 and 2015 was performed. The Yost index, a census tract-level composite score of SES, was used to categorize patients. Kaplan-Meier analysis and Cox regression for disease-specific survival were stratified by SES. CDSS was calculated with simplified models. Logistic regression was conducted to identify risk factors for advanced stage at diagnosis, multimodal therapy, and diagnosis of squamous cell carcinoma.
RESULTS: There were 3437 patients analyzed. In Cox models adjusting for patient-specific factors, the lowest SES tertile exhibited worse mortality (hazard ratio, 1.22; 95% CI, 1.07-1.39; P < .01). After addition of treatment and pathology, SES was not significant (P = .07). The lowest SES tertile was more often diagnosed at later stages (odds ratio [OR], 1.52; 95% CI, 1.12-2.06; P < .01). For those with regional/distant disease, the middle tertile (OR, 0.75; 95% CI, 0.63-0.90; P < .01) and lowest tertile (OR, 0.75; 95% CI, 0.62-0.91; P < .01) were less likely to receive multimodal therapy. SES tertiles primarily affected 5-year CDSS for regional/distant disease. CDSS for all stages converged over time.
CONCLUSIONS: Lower SES is associated with worse outcomes in paranasal sinus cancer. Research should be devoted toward understanding factors that contribute to such disparities, including tumor pathology and treatment course.
摘要：
目标：社会经济地位（SES）通常用于量化健康的社会决定因素。本研究使用美国国家癌症研究所SES指数来检查SES对鼻旁窦癌中疾病特异性生存率和5年条件性疾病特异性生存率（CDSS；预期寿命随生存率增加而变化）的影响。
方法：横断面分析。
方法：国家癌症研究所的监测，流行病学和最终结果（SEER）计划。
方法：对1973年至2015年间患有鼻窦癌的成年人进行了研究。Yost指数，SES的人口普查道级别综合评分，用于对患者进行分类。通过SES对疾病特异性生存的Kaplan-Meier分析和Cox回归进行分层。CDSS采用简化模型计算。进行Logistic回归以确定诊断晚期的危险因素。多模式疗法,鳞状细胞癌的诊断。
结果：对3437例患者进行了分析。在针对患者特定因素进行调整的Cox模型中，最低的SES三角表现出更低的死亡率(危险比，1.22；95%CI，1.07-1.39；P<0.01）。在添加治疗和病理后，SES不显著(P=0.07)。SES最低的三分位数更常见于晚期阶段(比值比[OR]，1.52；95%CI，1.12-2.06；P<0.01）。对于那些患有区域/远处疾病的人，中间三元语(或，0.75；95%CI，0.63-0.90；P<0.01）和最低三分位数（OR，0.75；95%CI，0.62-0.91；P<.01）接受多模式治疗的可能性较小。SES三元率主要影响区域/远处疾病的5年CDSS。所有阶段的CDSS随时间收敛。
结论：较低的SES与鼻旁窦癌预后较差相关。研究应该致力于理解导致这种差异的因素，包括肿瘤病理和治疗过程。
方法：横断面分析。
方法：国家癌症研究所的监测，流行病学和最终结果（SEER）计划。
方法：对1973年至2015年间患有鼻窦癌的成年人进行了研究。Yost指数，SES的人口普查道级别综合评分，用于对患者进行分类。通过SES对疾病特异性生存的Kaplan-Meier分析和Cox回归进行分层。CDSS采用简化模型计算。进行Logistic回归以确定诊断晚期的危险因素。多模式疗法,鳞状细胞癌的诊断。
结果：对3437例患者进行了分析。在针对患者特定因素进行调整的Cox模型中，最低的SES三角表现出更低的死亡率(危险比，1.22；95%CI，1.07-1.39；P<0.01）。在添加治疗和病理后，SES不显著(P=0.07)。SES最低的三分位数更常见于晚期阶段(比值比[OR]，1.52；95%CI，1.12-2.06；P<0.01）。对于那些患有区域/远处疾病的人，中间三元语(或，0.75；95%CI，0.63-0.90；P<0.01）和最低三分位数（OR，0.75；95%CI，0.62-0.91；P<.01）接受多模式治疗的可能性较小。SES三元率主要影响区域/远处疾病的5年CDSS。所有阶段的CDSS随时间收敛。
结论：较低的SES与鼻旁窦癌预后较差相关。研究应该致力于理解导致这种差异的因素，包括肿瘤病理和治疗过程。
