PO.PR01.01 · 预防研究
胸腺癌根治性手术可及性中的人口学和社会经济差异：一项基于人群的研究
Demographic and socioeconomic disparities in access to curative-intent surgery for thymic carcinoma: A population based study.
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
胸腺癌是一种罕见、侵袭性的胸部恶性肿瘤，手术是唯一潜在的根治性治疗。全国范围内手术评估和治疗可及性的不平等仍未得到充分界定。我们进行了迄今最大规模的基于人群的分析，以评估分期表现和根治性手术中的人口学和社会经济差异。
从SEER（2010-2022）中查询了经组织学确诊的成人胸腺癌患者（ICD-O-3: 8586/3）。变量包括年龄、性别、种族/族裔、家庭收入中位数、城乡分类、分期（Derived EOD 2018）、手术、化疗、放疗和“未行癌症导向手术的原因”。“不建议手术”被用作临床不可手术或手术评估可及性受限的替代指标。使用χ²和多变量逻辑回归评估关联，校正年龄、性别、收入、城乡和分期组。生存采用观察生存月数评估。
在1,009例患者中，队列62%为男性且种族多样（白人51%，黑人17%，亚裔/太平洋岛民16%，西班牙裔15%）。66%的病例分期未记录。在已分期病例中，转移性疾病占主导（18%）；早期（I-II）疾病占10%。54%的患者接受了手术，而41%的患者“不建议手术”。早期患者中87%接受了手术，而转移性病例中仅33%（p<0.001）。观察到显著的种族差异：“不建议手术”在黑人（53.5%）、西班牙裔（45.7%）、亚裔/太平洋岛民（41.1%）和白人（42.9%）患者中的比例。校正后，黑人患者相较白人患者“不建议手术”的几率显著更高（OR 1.61；95% CI 1.11-2.35；p=0.01）。晚期和分期不明强烈预示不建议手术（p<0.001）。治疗延迟>90天在非都市县更为频繁（8.8%对4.6%）。接受手术的患者中位生存期明显长于不建议手术者（45对15个月）。
在美国，实质性的种族和社会经济不平等限制了胸腺癌根治性手术的可及性。黑人患者经历了显著更高的校正后“不建议手术”几率，独立于分期、收入和城乡因素。分期记录缺失率高以及非都市地区治疗延迟延长进一步阻碍了公平的医疗服务提供。这些发现凸显了对标准化分期、通往胸外科肿瘤学的公平转诊路径以及系统级干预的迫切需求，以改善这种罕见恶性肿瘤根治性治疗的可及性。
查看英文原文 English abstract
Thymic carcinoma is a rare, aggressive thoracic malignancy in which surgery is the only potentially curative therapy. National inequities in surgical evaluation and treatment access remain poorly defined. We performed the largest population-based analysis to evaluate demographic and socioeconomic disparities in stage presentation and curative-intent surgery.
SEER (2010-2022) was queried for adults with histologically confirmed thymic carcinoma (ICD-O-3: 8586/3). Variables included age, sex, race/ethnicity, median household income, rural-urban classification, stage (Derived EOD 2018), surgery, chemotherapy, radiation, and “Reason for No Cancer-Directed Surgery.” “Surgery not recommended” was used as a proxy for clinical inoperability or limited access to surgical evaluation. Associations were assessed using χ² and multivariable logistic regression, adjusting for age, sex, income, rurality, and stage group. Survival was evaluated using observed survival months.
Among 1,009 patients, the cohort was 62% male and racially diverse (White 51%, Black 17%, Asian/Pacific Islander 16%, Hispanic 15%). Stage was undocumented in 66%. Among staged cases, metastatic disease predominated (18%); early-stage (I-II) disease comprised 10%. Surgery was performed in 54%, while 41% had surgery “not recommended.” Early-stage patients underwent surgery in 87% of cases versus 33% of metastatic cases (p < 0.001). Marked racial disparities were noted: surgery “not recommended” among Black (53.5%), Hispanic (45.7%), Asian/Pacific Islander (41.1%), and White (42.9%) patients. After adjustment, Black patients had significantly higher odds of surgery “not recommended” versus White patients (OR 1.61; 95% CI 1.11 - 2.35; p = 0.01). Advanced and unknown stage strongly predicted surgery not being recommended (p < 0.001). Treatment delays >90 days occurred more frequently in non-metropolitan counties (8.8% vs 4.6%). Median survival was markedly longer for patients who received surgery compared with those for whom surgery was not recommended (45 vs 15 months).
Substantial racial and socioeconomic inequities limit access to curative-intent surgery for thymic carcinoma in the United States. Black patients experienced significantly higher adjusted odds of surgery being deemed “not recommended,” independent of stage, income, and rurality. High rates of missing stage documentation and prolonged treatment delays in non-metropolitan regions further hinder equitable care delivery. These findings highlight urgent needs for standardized staging, equitable referral pathways to thoracic surgical oncology, and system-level interventions to improve access to curative treatment for this rare malignancy.
利益披露 Disclosure
C. M. Emeasoba, None..
C. Okoye, None..
G. Kamoga, None..
O. Ntukidem, None..
H. Jensen, None.