PDF(Pubmed)
Abstract：
Surgical margins following rectal cancer resection impact oncologic outcomes. We examined the relationship between margin status and race, ethnicity, region of care, and facility type. Patients undergoing resection of a stage II-III locally advanced rectal cancer (LARC) between 2004 and 2018 were identified through the National Cancer Database. Inverse probability of treatment weighting (IPTW) was performed, with margin positivity rate as the outcome of interest, and race/ethnicity and region of care as the predictors of interest. In total, 58,389 patients were included. After IPTW adjustment, non-Hispanic Black (NHB) patients were 12% (p = 0.029) more likely to have margin positivity than non-Hispanic White (NHW) patients. Patients in the northeast were 9% less likely to have margin positivity compared to those in the south. In the west, NHB patients were more likely to have positive margins than NHW patients. Care in academic/research centers was associated with lower likelihood of positive margins compared to community centers. Within academic/research centers, NHB patients were more likely to have positive margins than non-Hispanic Other patients. Our results suggest that disparity in surgical management of LARC in NHB patients exists across regions of the country and facility types. Further research aimed at identifying drivers of this disparity is warranted.
摘要：
直肠癌切除术后的手术切缘影响肿瘤学结果。我们研究了边缘状态和种族之间的关系，种族,护理区域,和设施类型。通过国家癌症数据库确定了2004年至2018年期间接受II-III期局部晚期直肠癌（LARC）切除术的患者。进行治疗加权的逆概率（IPTW），以保证金阳性率为利息的结果，以及种族/族裔和护理地区是感兴趣的预测因素。总的来说,包括58,389名患者。IPTW调整后，非西班牙裔黑人(NHB)患者比非西班牙裔白人(NHW)患者边缘阳性的可能性高12%(p=0.029).与南部患者相比，东北部患者的边缘阳性可能性低9％。在西方,NHB患者比NHW患者更有可能出现阳性切缘。与社区中心相比，学术/研究中心的护理与阳性边缘的可能性较低相关。在学术/研究中心内，NHB患者比非西班牙裔其他患者更可能有阳性切缘。我们的结果表明，在NHB患者中，LARC的手术管理存在差异。有必要进行进一步的研究，以确定这种差异的驱动因素。
