PO.PS01.02 · 人群科学
口腔鳞状细胞癌患者条件生存中的种族差异：一项基于监测、流行病学和最终结果的分析
Racial disparities in conditional survival among patients with oral cavity squamous cell carcinoma: A surveillance, epidemiology, and end results-based analysis
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摘要 Abstract
中文摘要
背景：口腔鳞状细胞癌（OCSCC）在美国头颈癌相关发病和死亡中占相当大的比例。在发病率、诊断时分期、手术护理可及性和总生存方面持续存在的种族差异已有充分记录。然而，传统的生存估计无法反映患者在诊断后存活最初几年后预后如何演变。条件生存（CS）提供了随时间变化的动态预后估计，可能更好地刻画种族生存差距的衰减。
方法：利用SEER数据库，我们对2004-2015年间诊断为OCSCC的24632名个体进行了一项基于人群的回顾性分析。采用Kaplan-Meier方法计算5年癌症特异性CS。使用包括种族、年龄、各种社会经济人口学、肿瘤分级和分期、亚部位以及治疗方式在内的信息进行多变量Cox回归分析，获得种族的5年死亡率风险比（HR）。所有分析均使用R（4.5.1版本）进行。
结果：在所分析的OCSCC患者中，80.6%为白人，8.7%为黑人，10.7%为亚裔/太平洋岛民（API）。初始5年CS显示出显著差异：黑人患者（43.2%）的生存率大幅低于白人（62.4%）和API患者（63.1%）。然而，条件生存表现出动态收敛模式。至治疗后第5年，生存者的差异缩小：黑人患者达到84.7%，白人患者87.8%，API患者88.9%的5年条件生存。时变多变量Cox回归揭示了演变中的死亡模式。黑人患者早期面临较高的死亡风险（第0年HR：1.15，95% CI：1.06-1.24；第1年HR：1.22，95% CI：1.09-1.36），但这种超额风险在长期生存者中消失（第4年HR：1.05，P=0.651；第5年HR：1.08，P=0.589）。API患者在所有时间点上始终显示出与白人患者相当的结局（HR：0.87-1.02，所有P>0.05）。
结论：OCSCC的种族生存差异遵循收敛轨迹。虽然黑人患者初始结局显著较差，但这一差距在5年生存者中缩小至仅3个百分点，同时调整模型中超额死亡风险完全消失。这种差异在治疗后头三年内的时间集中可能提示治疗中的早期因素（如诊断延迟、治疗障碍）是早期死亡的驱动因素。API与白人患者相比无统计学显著差异。
查看英文原文 English abstract
Background: Oral cavity squamous cell carcinoma (OCSCC) accounts for a substantial proportion of head and neck cancer-related morbidity and mortality in the United States. Persistent racial disparities in incidence, stage at diagnosis, access to surgical care, and overall survival have been well documented. Traditional survival estimates, however, do not reflect how prognosis evolves after patients survive the initial years following diagnosis. Conditional survival (CS) offers a dynamic estimate of prognosis over time and may better characterize the attenuation of racial survival gaps.
Methods: Using the SEER database, we conducted a population-based retrospective analysis of 24632 individuals diagnosed with OCSCC between 2004-2015. 5-year cancer-specific CS was calculated using the Kaplan-Meier method. Information including race, age, various socioeconomic demographics, tumor grade and stage, subsite, and treatment modality was used to perform multivariable Cox regression analysis and obtain hazard ratios (HRs) of 5-year mortality for race. All analyses were conducted using R (version 4.5.1).
Results: Of the OCSCC patients analyzed, 80.6% were White, 8.7% Black, and 10.7% Asian/Pacific Islander (API). Initial 5-year CS revealed marked disparities: Black patients (43.2%) had substantially lower survival than White (62.4%) and API patients (63.1%). However, conditional survival demonstrated a dynamic convergence pattern. By year 5 post-treatment, survivors showed narrowed differences: Black patients reached 84.7%, White patients 87.8%, and API patients 88.9% 5-year conditional survival. Time-varying multivariable Cox regression revealed evolving mortality patterns. Black patients faced increased death risk early (Year 0 HR: 1.15, 95% CI: 1.06-1.24; Year 1 HR: 1.22, 95% CI: 1.09-1.36), but this excess risk disappeared among long-term survivors (Year 4 HR: 1.05, P = 0.651; Year 5 HR: 1.08, P = 0.589). API patients consistently showed comparable outcomes to White patients across all timepoints (HRs: 0.87-1.02, all P > 0.05).
Conclusion: OCSCC racial survival disparities follow a convergence trajectory. While Black patients experience significantly worse outcomes initially, this gap contracts to just 3 percentage points among 5-year survivors, accompanied by complete resolution of excess mortality risk in adjusted models. This temporal concentration of disparities within the first three post-treatment years may implicate early-phase factors in treatment (e.g., diagnostic delays, treatment barriers) as drivers in early mortality. There was no statistically significant difference in API compared to White patients.
利益披露 Disclosure
I. Wang, None..
B. Wang, None..
N. Kornblum, None.