Esophageal cancer: less surgery may explain higher mortality in black patients

  • Dong J & al.
  • Clin Gastroenterol Hepatol
  • 20 Jul 2018

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Black patients with esophageal cancer are significantly less likely than non-Hispanic whites (NHWs) to undergo surgery, which accounts for the higher mortality rate among black patients.

Why this matters

  • Even when NHW patients had the same disease presentation as black patients, whites were more than twice as likely to undergo surgery than blacks.

Study design

  • 17,423 patients newly diagnosed with esophageal adenocarcinoma (EAC, n=10,774) and esophageal squamous cell carcinoma (ESCC, n=6649; 10.9% black, 89.1% white) from the Surveillance Epidemiology and End Results database between 1994 and 2011 were included.
  • Matched cohorts based on demographics, presentation, and treatment.
  • Funding: None disclosed.

Key results

  • Blacks were significantly less likely to receive surgery than NHWs, even after demographic and presentation matching (10.8% vs 22.8%; P<.001>
  • Black race/ethnicity significantly associated with higher mortality when adjusted for demographics and presentation (black vs NHW, HR, 1.14; 95% CI, 1.03-1.25), but not when adjusted for treatment (HR, 1.04; 95% CI, 0.94-1.14).
  • Type of surgery was not associated with survival disparity.
  • When matched for presentation and adjusted for surgery, black race/ethnicity was not associated with mortality risk (HR, 1.05; 95% CI, 0.95-1.16).

Limitations

  • Findings based on claims data.

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