Race and Ethnicity Impacts Overall Survival of Patients with Appendiceal Cancer Who Undergo Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Case Identification
2.2. Statistical Analysis
3. Results
3.1. Patient Sociodemographics
3.2. Cancer Characteristics and Treatment Outcomes
3.3. Survival Analysis
3.4. Factors Associated with Overall Survival
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Non-Hispanic White (n = 2098) | Non-Hispanic Black (n = 186) | Hispanic (n = 127) | Other (n = 121) | p-Value |
---|---|---|---|---|---|
Sex Male Female | 999 (47.6%) 1099 (52.4%) | 71 (38.2%) 115 (61.8%) | 45 (35.4%) 82 (64.6%) | 57 (47.1%) 64 (52.9%) | 0.006 |
Age (y) | 57.0 [48.0, 65.0] | 55.0 [44.0, 62.0] | 50.0 [40.0, 61.0] | 59.0 [49.0, 65.0] | <0.001 |
Insurance Private Medicaid Medicare Other Govt Uninsured Unknown | 1435 (68.4%) 69 (3.3%) 497 (23.7%) 40 (1.9%) 28 (1.3%) 29 (1.4%) | 109 (58.6%) 19 (10.2%) 35 (18.8%) 14 (7.5%) 5 (2.7%) 4 (2.2%) | 71 (55.9%) 21 (16.5%) 24 (18.9%) 3 (2.4%) 6 (4.7%) 2 (1.6%) | 71 (58.7%) 11 (9.1%) 30 (24.8%) 3 (2.5%) 4 (3.3%) 2 (1.7%) | <0.001 |
Distance (miles) | 36.6 [11.7, 122.3] | 25.0 [6.4, 96.2] | 19.8 [7.3, 91.0] | 17.9 [7.7, 47.0] | <0.001 |
Urban vs. Rural Metro Urban Rural Unknown | 1519 (72.4%) 220 (10.5%) 31 (1.5%) 328 (15.6%) | 146 (78.5%) 9 (4.8%) 2 (1.1%) 29 (15.6%) | 113 (89.0%) 6 (4.7%) 0 (0.0%) 8 (6.3%) | 105 (86.8%) 3 (2.5%) 0 (0.0%) 13 (10.7%) | <0.001 |
Facility Type * CCP CCCP ARP INCP Unknown | 28 (1.3%) 367 (17.5%) 1260 (60.1%) 217 (10.3%) 226 (10.8%) | 3 (1.6%) 26 (14.0%) 106 (57.0%) 19 (10.2%) 32 (17.2%) | 1 (0.8%) 11 (8.7%) 67 (52.8%) 23 (18.1%) 25 (19.7%) | 2 (1.7%) 26 (21.5%) 73 (60.3%) 13 (10.7%) 7 (5.8%) | 0.001 |
Location Atlantic Central Mountain New England Pacific Unknown | 848 (40.4%) 632 (30.1%) 69 (3.3%) 120 (5.7%) 203 (9.7%) 226 (10.8%) | 99 (53.2%) 37 (19.9%) 1 (0.5%) 6(3.2%) 11 (5.9%) 32 (17.2%) | 42 (33.1%) 24 (18.9%) 4 (3.2%) 5 (3.9%) 27 (21.3%) 25 (19.7%) | 44 (36.4%) 33 (27.3%) 2 (1.7%) 4 (3.3%) 31 (25.6%) 7 (5.8%) | <0.001 |
% without High School Degree ≥17.6% 10.9–17.5% 6.3–10.8% <6.3% Unknown | 219 (10.4%) 382 (18.2%) 553 (26.4%) 601 (28.7%) 343 (16.4%) | 49 (26.3%) 50 (26.9%) 32 (17.2%) 21 (11.3%) 34 (18.3%) | 47 (37.0%) 19 (15.0%) 26 (20.5%) 14 (11.0%) 21 (16.5%) | 19 (15.7%) 21 (17.4%) 29 (24.0%) 34 (28.1%) 18 (14.9%) | <0.001 |
Median Income <USD 40,227 USD 40,227–50,353 USD 50,354–63,332 >USD 63,333 Unknown | 203 (9.7%) 305 (14.5%) 453 (21.6%) 789 (37.6%) 348 (16.6%) | 52 (28.0%) 38 (20.4%) 29 (15.6%) 32 (17.2%) 35 (18.8%) | 19 (15.0%) 28 (22.0%) 24 (18.9%) 35 (27.6%) 21 (16.5%) | 8 (6.6%) 7 (5.8%) 29 (24.0%) 59 (48.8%) 18 (14.9%) | <0.001 |
Year of Diagnosis 2006–2010 2011–2014 2015–2018 | 535 (25.5%) 639 (30.5%) 924 (44.0%) | 44 (23.7%) 51 (27.4%) 91 (48.9%) | 22 (17.3%) 38 (29.9%) 67 (52.8%) | 28 (23.1%) 41 (33.9%) 52 (43.0%) | 0.29 |
Charlson–Deyo 0 1 2 ≥3 | 1779 (84.8%) 256 (12.2%) 40 (1.91%) 23 (1.1%) | 149 (80.1%) 26 (14.0%) 8 (4.3%) 3 (1.6%) | 107 (84.3%) 13 (10.2%) 5 (3.9%) 2 (1.6%) | 94 (77.7%) 20 (16.5%) 6 (5.0%) 1 (0.8%) | 0.12 |
Variable | Non-Hispanic White (n = 2098) | Non-Hispanic Black (n = 186) | Hispanic (n = 127) | Other (n = 121) | p-Value |
---|---|---|---|---|---|
Tumor Grade Well-differentiated Moderately differentiated Poorly differentiated Undifferentiated Undetermined Unknown | 692 (33.0%) 445 (21.2%) 277 (13.2%) 49 (2.3%) 395 (18.8%) 240 (11.4%) | 61 (32.8%) 40 (21.5%) 18 (9.7%) 2 (1.0%) 39 (21.0%) 26 (14.0%) | 45 (35.4%) 37 (29.1%) 10 (7.9%) 0 (0.0%) 20 (15.8%) 15 (11.8%) | 38 (31.4%) 30 (24.8%) 11 (9.1%) 3 (2.5%) 24 (19.8%) 15 (12.4%) | 0.39 |
Margins R0/R1 R2 Residual, NOS * Unknown | 1276 (60.8%) 129 (6.2%) 229 (10.9%) 464 (22.1%) | 121 (65.1%) 17 (9.1%) 19 (10.2%) 29 (15.6%) | 77 (60.6%) 7 (5.5%) 5 (3.9%) 38 (29.9%) | 72 (59.5%) 9 (7.4%) 12 (9.9%) 28 (23.1%) | 0.065 |
Hospital LOS (d) | 9.0 [6.0, 14.0] | 9.0 [7.0, 13.0] | 10.0 [6.0, 15.0] | 9.0 [6.0, 15.0] | 0.96 |
Readmission None Unplanned Planned Both Unknown | 1879 (89.6%) 130 (6.2%) 21 (1.0%) 3 (0.1%) 65 (3.1%) | 162 (87.1%) 14 (7.5%) 3 (1.6%) 0 (0.0%) 7 (3.8%) | 112 (88.2%) 9 (7.1%) 4 (3.2%) 0 (0.0%) 2 (1.6%) | 110 (90.9%) 6 (5.0%) 3 (2.5%) 0 (0.0%) 2 (1.6%) | 0.59 |
30 d Mortality | 18 (0.9%) | 4 (2.2%) | 0 (0.0%) | 0 (0.0%) | 0.36 |
90 d Mortality | 57 (2.8%) | 5 (2.7%) | 0 (0.0%) | 2 (1.7%) | 0.64 |
Length of Follow-Up (m) | 47.0 [27.2, 76.7] | 46.2 [26.7, 71.8] | 45.1 [27.4, 72.4] | 51.1 [30.0, 79.2] | 0.80 |
Overall Mortality | 688 (32.8%) | 73 (39.3%) | 22 (17.3%) | 29 (24.0%) | <0.001 |
Variable | Hazard Ratio | 95% Confidence Interval | p-Value | |
---|---|---|---|---|
Age | 1.02 | 1.02 | 1.03 | <0.001 |
Female | 0.84 | 0.73 | 0.97 | 0.015 |
Race | ||||
Non-Hispanic Black | 2.12 | 1.31 | 3.43 | 0.002 |
Non-Hispanic White | 1.55 | 1.01 | 2.38 | 0.046 |
Other | 1.09 | 0.62 | 1.92 | 0.76 |
Facility Type | ||||
CCP | 0.48 | 0.23 | 1.01 | 0.054 |
CCCP | 1.19 | 0.99 | 1.43 | 0.07 |
INCP | 1.13 | 0.88 | 1.45 | 0.33 |
Urban vs. Rural | ||||
Metro | 0.79 | 0.63 | 1 | 0.05 |
Rural | 0.57 | 0.26 | 1.24 | 0.16 |
Median Income | ||||
<USD 40,227 | 1.01 | 0.78 | 1.29 | 0.96 |
USD 40,227–50,353 | 1.13 | 0.91 | 1.41 | 0.26 |
USD 50,354–63,332 | 1.46 | 1.21 | 1.76 | <0.001 |
Days to Surgery from Diagnosis | 1 | 1 | 1.01 | <0.001 |
Tumor Grade | ||||
Moderately differentiated | 1.77 | 1.43 | 2.19 | <0.001 |
Poorly differentiated | 4.52 | 3.68 | 5.56 | <0.001 |
Undifferentiated | 3.16 | 2.07 | 4.82 | <0.001 |
Undetermined | 1.96 | 1.59 | 2.41 | <0.001 |
Margins | ||||
R2 | 1.96 | 1.53 | 2.5 | <0.001 |
Residual, NOS * | 2.04 | 1.67 | 2.49 | <0.001 |
Unknown | 1.4 | 1.17 | 1.68 | 0.021 |
Year of Diagnosis | ||||
2011–2014 | 0.82 | 0.69 | 0.97 | 0.021 |
2015–2018 | 0.67 | 0.55 | 0.82 | 0.001 |
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Freudenberger, D.C.; Vudatha, V.; Wolfe, L.G.; Riner, A.N.; Herremans, K.M.; Sparkman, B.K.; Fernandez, L.J.; Trevino, J.G. Race and Ethnicity Impacts Overall Survival of Patients with Appendiceal Cancer Who Undergo Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Cancers 2023, 15, 3990. https://doi.org/10.3390/cancers15153990
Freudenberger DC, Vudatha V, Wolfe LG, Riner AN, Herremans KM, Sparkman BK, Fernandez LJ, Trevino JG. Race and Ethnicity Impacts Overall Survival of Patients with Appendiceal Cancer Who Undergo Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Cancers. 2023; 15(15):3990. https://doi.org/10.3390/cancers15153990
Chicago/Turabian StyleFreudenberger, Devon C., Vignesh Vudatha, Luke G. Wolfe, Andrea N. Riner, Kelly M. Herremans, Brian K. Sparkman, Leopoldo J. Fernandez, and Jose G. Trevino. 2023. "Race and Ethnicity Impacts Overall Survival of Patients with Appendiceal Cancer Who Undergo Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy" Cancers 15, no. 15: 3990. https://doi.org/10.3390/cancers15153990