结肠直肠癌切除术后的社会脆弱性指数和生存率
Sabran J Masoud1, Jein E Seo2, Eden Singh2
1From the Department of Surgery, Duke University Medical Center, Durham, NC (Masoud, Mantyh).
Journal of the American College of Surgeons
|March 5, 2024
概括
高社会脆弱性指数 (SVI) 与更糟糕的结直肠癌 (CRC) 存活率有关. 社区层面的脆弱性影响了长期的CRC预后,这表明需要在患者护理中进行有针对性的外展.
科学领域:
- 在瘤学瘤学.
- 公共卫生 公共卫生
- 健康差距 研究 研究 研究 研究
背景情况:
- 仅仅种族和社会经济地位并不能完全确定患有结直肠癌 (CRC) 的患者存在高风险的差异.
- 社会脆弱性指数 (SVI) 量化了影响健康的社区层面 (社会经济,家庭,交通) 的障碍.
- 之前的研究将SVI与减少癌症中心使用量和结肠切除术后并发症联系起来,但其对长期CRC存活的影响尚不清楚.
研究的目的:
- 调查社会脆弱性指数 (SVI) 与结直肠癌 (CRC) 患者的长期生存结果之间的关联.
- 为了确定社区层面的社会脆弱性是否独立地预测手术切除后的CRC预后.
主要方法:
- 从2010年到2023年,对872名接受CRC切除I-IV阶段的患者进行了回顾性分析.
- 地理编码患者地址到SVI数据,并从电子健康记录中抽象临床病理信息.
- 使用Kaplan-Meier和Cox比例危险模型进行总生存率和癌症特异性生存率的比较,对共变量进行调整.
主要成果:
- 在最高SVI四分位数 (32%) 的患者更有可能是黑人,私人保险较少,并具有较高的并发症.
- 高SVI独立地与CRC切除后增加的全因死亡率 (HR 1.48,p < 0.01) 和癌症特异性死亡率 (HR 1.71,p = 0.02) 相关.
- 根据SVI,没有观察到尖度,阶段或CRC治疗的显著差异.
结论:
- 高社会脆弱性指数是结直肠癌切除后长期预后较差的独立预测指标.
- 邻居层面的脆弱性可能是影响CRC结果的关键因素,超出了外科手术期间.
- 调查结果表明,SVI可以为有针对性的外展策略提供信息,以减轻CRC护理中的差异.
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