背景:高分化甲状腺癌(WDTC)是最常见的甲状腺恶性肿瘤,全球发病率正在上升。早期疾病可以通过手术治愈。我们假设,居住在距离医疗机构更远的地方或具有复杂的社会经济障碍的患者可能会出现更晚期的疾病并具有更差的结果。
方法:国家癌症数据库(NCDB)用于识别2004年至2018年间诊断为WDTC的患者。种族,种族,保险状况,收入状况,分析了从居住地到诊断诊所的距离(大圆距离[GCD]),并分析了疾病的严重程度(分期)和结局。二元逻辑回归和Cox回归用于确定社会经济变量与肿瘤分期或生存之间的关联。
结果:与白人人群相比,西班牙裔(OR:1.49,CI:1.45-1.54,P<0.001)和亚洲裔(OR:1.49,CI:1.43-1.55,P<0.001)人群发生晚期疾病的几率更高。与有保险的患者相比,没有保险的患者在诊断时出现晚期疾病的几率更高(OR:1.39,CI:1.31-1.47,P<0.001)。生存的校正Cox回归分析显示,与白人患者相比,黑人患者具有不利的生存结果(HR:1.24,P<0.001),与没有保险的患者相比,有私人保险的患者的生存结果有所改善(HR:0.58,P<0.001)。
结论:与白人相比,西班牙裔和亚裔患者更有可能出现晚期疾病,但总体生存率也更高。黑人人口,没有保险的病人,收入较低的患者的生存结局较差。
Well-differentiated thyroid cancer (WDTC) is the most common thyroid malignancy, and the worldwide incidence is increasing. Early stage disease is curable with surgery. We hypothesized that patients who live at greater distances from health care institutions or have complicating socioeconomic barriers may present with more advanced diseases and have worse outcomes.
The National Cancer Database (NCDB) was used to identify patients who were diagnosed with WDTC between 2004 and 2018. Race, ethnicity, insurance status, income status, and distance from residence to health care clinic of diagnosis (great circle distance [GCD]) were analyzed with respect to the severity of disease at presentation (stage) and outcomes. Binary logistic regression and Cox regression were used to determine associations between socioeconomic variables and tumor stage or survival.
The Hispanic (OR: 1.49, CI: 1.45-1.54, P < 0.001) and Asian (OR: 1.49, CI: 1.43-1.55, P < 0.001) populations had higher odds of developing an advanced disease when compared to the White population separately. Patients without insurance displayed higher odds of developing an advanced disease at diagnosis compared to those with insurance (OR: 1.39, CI: 1.31-1.47, P < 0.001). Adjusted-Cox regression analysis of survival revealed that Black patients had detrimental survival outcomes when compared to White patients (HR: 1.24, P < 0.001), and patients with private insurance had improved survival outcomes when compared to those without insurance (HR: 0.58, P < 0.001).
Hispanic and Asian patients were found to be more likely to present with an advanced disease but also displayed greater overall survival when compared to the White population. The Black population, patients without insurance, and patients with lower income status exhibited worse survival outcomes.