Article record

美国社区层面脆弱性关联与早发和晚发鼻咽癌预后差异

Differences of Community-Level Vulnerability Associations With Early- and Later-Onset Nasopharyngeal Cancer Prognosis in the United States.

临床研究鼻咽癌IF 2.9Q1

文献信息

PMID	42726934
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Eric Pan 查看其他 9 位作者 Hari Patel；David Fei-Zhang；Jill D'Souza；Anthony Sheyn；Abhinav Talwar；Jorge Gutierrez；Christopher Puchi；Daniel Chelius；Jeffrey Rastatter
作者单位	Medical College of Georgia-Augusta University Augusta, Georgia, USA. 查看其他 9 条单位信息 Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.；Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.；Louisiana State University Health Sciences Center Department of Otolaryngology and Division of Pediatric Otolaryngology Children's Hospital of New Orleans, New Orleans, Los Angeles, USA.；Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.；Department of Pediatric Otolaryngology, LeBonheur Children's Hospital, Memphis, Tennessee, USA.；Otolaryngology Division, Surgery Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.；Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.；Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, USA.；Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
期刊	Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
SCI 分区	Q1
IF	2.9
研究类型	临床研究 · 临床
所属专科	鼻咽癌

中文摘要

目的： 评估鼻咽癌患者中社区、社会脆弱性关联与护理及预后相关的年龄差异。
研究设计： 回顾性队列。
地点： 美国。
方法： 这项回顾性队列研究纳入1975年至2017年的12,480例鼻咽癌患者，并关联15项县级脆弱性指标，涵盖社会经济地位（SES）、少数族裔语言状态（ML）、家庭构成（HH）、住房-交通（HT），以及一个总/复合脆弱性主题；通过调整后的线性回归和逻辑回归分析进行评估，并按20至44岁（较年轻）和≥45岁（较年长）年龄组分层，结局包括生存、多模式治疗和晚期分期。
结果： 总脆弱性增加与较年轻年龄组生存期减少45%（78.3-43.1个月）相关，而较年长组仅减少22%（50.8-39.9个月）。总脆弱性增加与较年轻组化疗增加（OR 1.17；95% CI 1.10-1.24）和外照射放疗减少（OR 0.78；95% CI 0.71-0.85）相关，而较年长组中化疗（1.07；1.04-1.11）和外照射放疗（0.87；0.84-0.90）的差异相似但减弱。总脆弱性增加还显示各年龄组晚期分期相似增加（较年轻组-1.09；1.03-1.11；较年长组-1.09，1.06-1.13）。从幅度上看，HH和SES脆弱性对这些趋势的贡献大于ML和HT。
结论： 社会脆弱性增加与鼻咽癌生存和治疗的不良趋势相关，较年轻患者的相关幅度显著高于较年长成人。由于这些趋势主要由HH和SES驱动因素构成，这些结果为应对早发鼻咽癌日益增长的担忧提供了前瞻性努力的可操作靶点。

英文摘要

OBJECTIVE: To assess age-related differences of community, social vulnerability associations with care and prognosis among those with nasopharyngeal carcinomas.
STUDY DESIGN: Retrospective Cohort.
SETTINGS: United States.
METHODS: This retrospective cohort study on 12,480 NPC-patients from 1975 to 2017 linked with 15 county-level vulnerability measures encompassing socioeconomic status (SES), minority-language status (ML), household composition (HH), housing-transportation (HT), and a total/composite vulnerability themes were assessed via adjusted linear and logistic regression analyses stratified across age groups of 20 to 44 years (younger) and ≥45 years (older) for outcomes of survival, multimodal treatment, and advanced staging.
RESULTS: Increased total vulnerability was associated with 45% (78.3-43.1 months) reductions in survival period among younger ages but only 22% (50.8-39.9 months) decreases among older ones. Increased total vulnerability was associated with increased chemotherapy (OR 1.17; 95% CI 1.10-1.24) and decreased external beam radiotherapy (OR 0.78; 95% CI 0.71-0.85) among younger groups compared to similar but diminished differences in chemotherapy (1.07; 1.04-1.11) and external beam radiotherapy (0.87; 0.84-0.90) for older ones. Increasing total vulnerability also showed similarly increased advanced staging across ages (younger-1.09; 1.03-1.11; older-1.09, 1.06-1.13). By magnitude, HH and SES-vulnerabilities contributed to these trends over ML and HT.
CONCLUSIONS: Increasing social vulnerability was associated with detrimental survival and treatment NPC-trends, with younger patients experiencing substantially higher magnitude correlations compared to older adults. With these trends largely constituted by HH and SES-drivers, these results present actionable targets for prospective efforts tackling the growing concerns of early-onset NPC.