TY - JOUR
T1 - Treatment disparities affect outcomes for patients with stage I esophageal cancer
T2 - A national cancer data base analysis
AU - Moreno, Amy C.
AU - Zhang, Ning
AU - Verma, Vivek
AU - Giordano, Sharon H.
AU - Lin, Steven H.
N1 - Funding Information:
Conflicts of Interest: SH Lin has research funding from Elekta, STCube Pharmaceuticals, Peregrine, Hitachi Chemical Inc., and Roche/Genentech, has served as consultant for AstraZeneca, and received honoraria from US Oncology and ProCure.
Publisher Copyright:
© Journal of Gastrointestinal Oncology. All rights reserved.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Background: To examine patterns of care and outcomes for patients with stage I esophageal cancer (EC) in the United States. Methods: We identified patients in the National Cancer Data Base diagnosed with stage I EC from 2004 to 2012 and grouped them by primary treatment: esophagectomy (Eso), local excision (LE), concurrent chemoradiation (CRT), or observation (Obs). Multinomial logistic regression was used to predict receipt of treatments. Overall survival (OS) was estimated by Kaplan-Meier methods adjusted for inverse probability of treatment weighting (IPTW) and Cox proportional hazard regressions. Results: Of 5,480 patients, 2,312 (42%) underwent Eso, 1,250 (23%) LE, 758 (14%) CRT, and 1,160 (21%) Obs. LE use increased over time from 17% to 29% while Obs declined from 26% to 19%. Patients least likely to undergo surgery were older, had greater comorbidity, were uninsured, were treated at non-academic centers, and were Black. The rate of surgery for Black patients was half of that for White patients (33% vs. 67%). Postoperative mortality rates were higher after Eso vs. LE at 30 days (2.9% vs. 0.5%; P<0.001) and at 90 days (5.5% vs. 1.4%, P<0.001). Five-year OS was 59% with Eso, 63% LE, 29% CRT, and 31% Obs (P<0.001). On multivariate analysis, outcomes were best after LE [vs. Eso: hazard ratio (HR) =1.15, 95% CI: 1.01–1.30, P=0.037; CRT: HR =2.41, 95% CI: 2.09–2.78, P<0.001; Obs: HR =3.79, 95% CI: 3.33–4.32, P<0.001). Conclusions: Disparities are evident in the care of patients with stage I EC throughout the United States. LE was associated with favorable outcomes compared to Eso, CRT, and Obs.
AB - Background: To examine patterns of care and outcomes for patients with stage I esophageal cancer (EC) in the United States. Methods: We identified patients in the National Cancer Data Base diagnosed with stage I EC from 2004 to 2012 and grouped them by primary treatment: esophagectomy (Eso), local excision (LE), concurrent chemoradiation (CRT), or observation (Obs). Multinomial logistic regression was used to predict receipt of treatments. Overall survival (OS) was estimated by Kaplan-Meier methods adjusted for inverse probability of treatment weighting (IPTW) and Cox proportional hazard regressions. Results: Of 5,480 patients, 2,312 (42%) underwent Eso, 1,250 (23%) LE, 758 (14%) CRT, and 1,160 (21%) Obs. LE use increased over time from 17% to 29% while Obs declined from 26% to 19%. Patients least likely to undergo surgery were older, had greater comorbidity, were uninsured, were treated at non-academic centers, and were Black. The rate of surgery for Black patients was half of that for White patients (33% vs. 67%). Postoperative mortality rates were higher after Eso vs. LE at 30 days (2.9% vs. 0.5%; P<0.001) and at 90 days (5.5% vs. 1.4%, P<0.001). Five-year OS was 59% with Eso, 63% LE, 29% CRT, and 31% Obs (P<0.001). On multivariate analysis, outcomes were best after LE [vs. Eso: hazard ratio (HR) =1.15, 95% CI: 1.01–1.30, P=0.037; CRT: HR =2.41, 95% CI: 2.09–2.78, P<0.001; Obs: HR =3.79, 95% CI: 3.33–4.32, P<0.001). Conclusions: Disparities are evident in the care of patients with stage I EC throughout the United States. LE was associated with favorable outcomes compared to Eso, CRT, and Obs.
KW - Chemoradiation (CRT)
KW - Disparities
KW - Esophagectomy
KW - Stage I esophageal cancer
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U2 - 10.21037/jgo.2018.10.04
DO - 10.21037/jgo.2018.10.04
M3 - Article
C2 - 30788162
AN - SCOPUS:85060315865
SN - 2078-6891
VL - 10
SP - 74
EP - 84
JO - Journal of Gastrointestinal Oncology
JF - Journal of Gastrointestinal Oncology
IS - 1
ER -