PO.PS01.04 · 人群科学

老年患者胃癌治疗及相关不良事件中的差异

Disparities in gastric cancer treatment and related adverse events in older adults

编号 901 展板 14 时间 4/19 02:00–05:00 区域 Section 35 主讲 Nana Owusu, BA

分会场 Survivorship Research Addressing Cancer Disparities

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作者与单位 Authors & Affiliations

Nana Owusu¹, Jennifer Ferris², Ji Yoon Yoon³, Jeong Yun Yang², Josephine Soddano², Sophie Wagner², Chin Hur²

¹Columbia Univ. Vagelos College of Physicians & Surgeons, New York, NY,²Department of Medicine, Columbia University Irving Medical Center, New York, NY,³Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY

摘要 Abstract

中文摘要

背景：治疗相关不良事件（AE）中的差异可能是导致癌症结局种族差异的原因之一。在本研究中，我们对非西班牙裔白人（NHW）与非西班牙裔黑人（NHB）胃癌（GC）患者的治疗模式及相关AE进行了全面分析。方法：我们从SEER-Medicare数据库（2000-2017年）中检索年龄≥66岁、经组织学确诊的NHW和NHB GC患者。收集诊断后1年内关于化疗、手术和放疗的住院及门诊报销记录。若化疗方案与2025年NCCN GC指南的一线/二线方案一致，则归类为"NCCN"，否则归类为"非NCCN"。参照既往SEER-Medicare研究，通过治疗后21天内血液学、胃肠道、感染性及代谢性毒性的住院报销记录识别化疗相关AE。队列间差异采用χ²检验或t检验进行检验。为控制每例患者的重复观测（如治疗周期），我们采用多变量广义估计方程测量种族与AE之间的关联。结果：该队列纳入18,089例患者（15,824例NHW；2,265例NHB）。两个队列的SEER分期分布一致（转移性疾病33% vs. 34%，P=0.32）。NHW患者男性比例更高（64% vs. 55%，P<0.01），贲门原发癌更多（59.9% vs. 37.0%，P<0.01），而NHB患者合并症更多（NCI指数均值0.64 vs. 0.50，P<0.01）。相较于NHW，NHB接受化疗（aOR 0.80，95% CI 0.71-0.89）或放疗（aOR 0.76，95% CI 0.66-0.86）的可能性更低，且从诊断到治疗开始的平均时间更长（化疗：82 vs. 73天；放疗：100 vs. 85天；两者P<0.01）。在5,748例化疗患者中（5,147例NHW；601例NHB），NHW与NHB的平均治疗周期数无差异（5.0 vs. 5.2，P=0.19）。然而，NHB每次治疗的AE风险高于NHW（aOR 1.15，95% CI 1.02-1.30）。转移性疾病（aOR 1.49，95% CI 1.39-1.59）和非NCCN方案（aOR 1.31，95% CI 1.22-1.40）也与AE风险升高相关。进一步的亚组分析显示，在非NCCN队列中，NHB相对于NHW的AE风险更高（aOR 1.35，95% CI 1.10-1.65），但在NCCN队列中并非如此（aOR 1.11，95% CI 0.95-1.28）。结论：GC的NHB患者接受化疗或放疗的可能性低于NHW患者，且治疗延迟更长。NHB患者化疗相关AE的风险也更高，尤其是在使用非NCCN方案时。这些发现凸显了GC诊疗中持续存在的不平等，并支持进一步研究AE差异的结构性及生物学驱动因素。

查看英文原文 English abstract

Background: Disparities in treatment-related adverse events (AEs) may contribute to racial differences in cancer outcomes. In this study, we performed a comprehensive analysis of treatment patterns and related AEs between non-Hispanic White (NHW) and non-Hispanic Black (NHB) gastric cancer (GC) patients. Methods: We queried SEER-Medicare (2000-2017) for NHW and NHB patients aged ≥66 years with histologically confirmed GC. Inpatient and outpatient claims within 1 year of diagnosis were collected for chemotherapy, surgery, and radiation treatments. Chemotherapy treatments were classified as ‘NCCN' if consistent with first/second-line regimens per 2025 NCCN GC guidelines, and ‘non-NCCN' otherwise. Chemotherapy-related AEs were identified using hospitalization claims for hematologic, gastrointestinal, infectious, and metabolic toxicities within 21 days of treatment consistent with prior SEER-Medicare studies. Cohort differences were tested with χ² or t-tests. To control for repeated observations (e.g., treatment cycles) per patient, we used multivariable Generalized Estimating Equations to measure associations between race and AEs. Results: The cohort included 18,089 patients (15,824 NHW; 2,265 NHB). SEER stage distribution was consistent across both NHW and NHB cohorts (33% vs. 34% metastatic disease, P =0.32). NHW patients were more often male (64% vs. 55%, P <0.01) and had more cardia primaries (59.9% vs. 37.0%, P <0.01), while NHBs had higher comorbidities (mean NCI Index 0.64 vs. 0.50, P <0.01). NHBs were less likely to receive chemotherapy (aOR 0.80, 95% CI 0.71-0.89) or radiation (aOR 0.76, 95% CI 0.66-0.86), and had longer mean time to treatment initiation (chemotherapy: 82 vs. 73 days; radiation: 100 vs. 85 days; both P <0.01) than NHWs. Among 5,748 chemotherapy recipients (5,147 NHW; 601 NHB), mean treatment cycles did not differ between NHWs and NHBs (5.0 vs. 5.2, P =0.19). However, NHBs had higher AE risk (aOR 1.15, 95% CI 1.02-1.30) per treatment than NHWs. Metastatic disease (aOR 1.49, 95% CI 1.39-1.59) and non-NCCN regimens (aOR 1.31, 95% CI 1.22-1.40) were also associated with elevated AE risk. Further sub-group analyses showed higher AE risk for NHBs relative to NHWs in the non-NCCN cohort (aOR 1.35, 95% CI 1.10-1.65) but not in the NCCN cohort (aOR 1.11, 95% CI 0.95-1.28). Conclusions: NHB patients with GC were less likely to receive chemotherapy or radiotherapy and experienced longer treatment delays than NHW patients. NHB patients also had greater risk of chemotherapy-related AEs, particularly when using non-NCCN regimens. These findings highlight persistent inequities in GC care and support further investigation into structural and biological drivers of AE disparities.

利益披露 Disclosure

N. Owusu, None.. J. Ferris, None.. J. Yoon, None.. J. Yang, None.. J. Soddano, None.. S. Wagner, None.. C. Hur, None.

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