Socioeconomic Deprivation Is Not Associated with Outcomes after Esophagectomy at a German High-Volume Center
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Selection
2.2. Treatment
2.3. Definition of Socioeconomic Status
2.4. Further Data Retrieval
2.5. Statistical Analysis
3. Results
3.1. Associations of Socioeconomic Status and Cohort Characteristics
3.2. Associations of Socioeconomic Status and 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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Characteristics | All Patients (N = 310) | Low Socioeconomic Status (Income ≤ EUR 24,000/Year, N = 154) | High Socioeconomic Status (Income > EUR 24,000/year, N = 156) | p-Value |
---|---|---|---|---|
Age [years (IQR)] | 64 (57–72) | 63 (56–70) | 67 (58–72) | 0.120 |
Sex [n (%)] | 0.445 | |||
Male | 242 (78.1) | 123 (39.7) | 119 (38.4) | |
Female | 68 (21.9) | 31 (10.0) | 37 (11.9) | |
Average income [EUR/year (IQR)] | 24,145 (21,399–26,474) | 21,399 (20,057–22,496) | 26,452 (24,717–28,293) | <0.001 |
Type of health insurance | ||||
Statutory health insurance (SHI) | 260 (83.9) | 136 (43.9) | 124 (40.0) | 0.035 |
Private health insurance (PHI) | 50 (16.1) | 18 (5.8) | 32 (10.3) | |
Charlson Comorbidity Index (IQR) | 4 (3–5) | 4 (3–5) | 4 (3–6) | 0.815 |
Nicotine abuse | 0.040 | |||
Yes | 133 (42.9) | 75 (24.2) | 58 (18.7) | |
No | 177 (57.1) | 79 (25.5) | 98 (31.6) | |
Alcohol abuse | 0.577 | |||
Yes | 52 (16.8) | 24 (7.7) | 28 (9.0) | |
No | 258 (83.2) | 130 (41.9) | 128 (41.3) | |
BMI (kg/m2(IQR) | 25.1 (22.2–28.1) | 25.2 (22.7–29.0) | 24.9 (21.8–27.5) | 0.054 |
Entity [n (%)] | 0.965 | |||
Adenocarcinoma | 204 (65.8) | 100 (32.3) | 104 (33.5) | |
Squamous cell carcinoma | 99 (31.9) | 50 (16.1) | 49 (15.8) | |
Other | 7 (2.3) | 4 (1.3) | 3 (1.0) | |
Preoperative treatment [n (%)] | 0.662 | |||
FLOT | 64 (20.6) | 36 (11.6) | 28 (9.0) | |
CROSS | 79 (25.5) | 28 (9.0) | 41 (13.2) | |
Definitive radiochemotherapy | 15 (4.8) | 7 (2.3) | 7 (2.3) | |
None | 152 (49.0) | 72 (23.2) | 80 (25.2) | |
Type of access [n (%)] | 0.839 | |||
Open | 139 (44.8) | 70 (22.6) | 69 (22.3) | |
Laparoscopic | 89 (28.7) | 46 (14.8) | 43 (13.9) | |
Hybrid | 48 (15.5) | 21 (6.8) | 27 (8.7) | |
Robotic | 34 (11.0) | 17 (5.5) | 17 (5.5) | |
UICC classification 8th edition [n (%)] | 0.542 | |||
0 | 26 (8.4) | 12 (3.9) | 14 (4.5) | |
I | 68 (21.9) | 38 (12.3) | 30 (9.7) | |
II | 69 (22.3) | 34 (11.0) | 35 (11.3) | |
III | 112 (36.1) | 50 (16.1) | 62 (20) | |
IV | 35 (11.3) | 20 (6.5) | 15 (4.8) | |
Tumor staging (pT) [n (%)] | 0.490 | |||
pT0 | 36 (11.6) | 18 (5.8) | 18 (5.8) | |
pT1a | 20 (6.5) | 12 (3.9) | 8 (2.6) | |
pT1b | 59 (19.0) | 30 (9.7) | 29 (9.4) | |
pT2 | 50 (16.1) | 27 (8.7) | 23 (7.4) | |
pT3 | 137 (44.2) | 61 (19.7) | 76 (24.5) | |
pT4a | 6 (1.9) | 4 (1.3) | 2 (0.6) | |
pT4b | 2 (0.6) | 2 (0.6) | 0 (0) | |
Lymph node staging (pN) [n (%)] | 0.433 | |||
pN0 | 157 (50.6) | 84 (27.1) | 73 (23.5) | |
pN1 | 65 (21.0) | 32 (10.3) | 33 (10.6) | |
pN2 | 54 (17.4) | 22 (7.1) | 32 (10.3) | |
pN3 | 34 (11.0) | 16 (5.2) | 18 (5.8) | |
Resection status [n (%)] | 0.284 | |||
R0 | 285 (91.9) | 144 (46.5) | 141 (45.5) | |
R1 | 8 (7.7) | 9 (2.9) | 15 (4.8) | |
R2 | 1 (0.3) | 1 (0.3) | 0 (0) | |
Clavien–Dindo Classification [n (%)] | 0.443 | |||
I | 73 (23.5) | 40 (12.9) | 33 (10.6) | |
II | 73 (23.5) | 36 (11.6) | 37 (11.9) | |
IIIa | 30 (9.7) | 9 (2.9) | 21 (6.8) | |
IIIb | 37 (11.9) | 20 (6.5) | 12 (3.9) | |
IVa | 45 (14.5) | 22 (7.1) | 23 (7.4) | |
IVb | 8 (2.6) | 4 (1.3) | 4 (1.3) | |
V (in-hospital death) | 44 (14.2) | 23 (7.4) | 21 (6.8) | |
Adjuvant treatment [n (%)] | ||||
Radiotherapy | 21 (6.8) | 10 (3.2) | 11 (3.5) | 0.845 |
Chemotherapy (including FLOT) | 91 (29.4) | 43 (13.9) | 48 (15.5) | 0.582 |
Characteristics | N (%) | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|---|
Median Survival in Months (95% CI) | p-Value (Log-Rank Test) | Hazard Ratio (95% CI) | p-Value (Cox Regression) | ||
Age | 0.015 | 0.666 | |||
<50 | 32 (10.3) | 53 (36–71) | - | ||
50–59 | 75 (24.2) | 55 (44–66) | 1.21 (0.60–2,44) | ||
60–69 | 106 (34.2) | 49 (39–58) | 1.25 (0.64–2.44) | ||
70–79 | 78 (25.2) | 44 (33–55) | 1.87 (0.72–4.87) | ||
≥80 | 19 (6.1) | 19 (8–30) | 2.21 (0.74–6.61) | ||
Gender [n (%)] | 0.590 | - | |||
Male | 242 (78.1) | 50 (44–57) | - | ||
Female | 68 (21.9) | 38 (29–47) | - | ||
Socioeconomic Status | 0.748 | 0.454 | |||
Low SES (Income ≤ EUR 24,000/year) | 50 (42–58) | - | |||
High SES (Income > EUR 24,000/year) | 43 (36–49) | 0.86 (0.59–1.27) | |||
Type of health insurance | 0.903 | - | |||
Statutory health insurance (SHI) | 260 (83.9) | 49 (43–55) | - | ||
Private health insurance (PHI) | 50 (16.1) | 48 (35–61) | - | ||
Charlson Comorbidity Index (SD) | 0.007 | 0.879 | |||
Low (≤4) | 54 (47–62) | - | |||
High (>5) | 42 (34–51) | 1.05 (0.53–2,08) | |||
Entity [n (%)] | 0.325 | - | |||
Adenocarcinoma | 204 (65.8) | 50 (43–57) | - | ||
Squamous cell carcinoma | 99 (31.9) | 45 (36–54) | - | ||
Type of access [n (%)] | 0.014 | 0.06 | |||
Open | 139 (44.8) | 41 (33–48) | - | ||
Laparoscopic | 89 (28.7) | 59 (49–69) | 0.54 (0.34–0.68) | ||
Hybrid | 48 (15.5) | 53 (39–68) | 0.72 (0.41–1.24) | ||
Robotic | 34 (11.0) | 35 (26–44) | 0.72 (0.40–1.31) | ||
UICC classification 8th edition [n (%)] | <0.001 | <0.001 | |||
0 | 26 (8.4) | 44 (33–55) | - | ||
I | 68 (21.9) | 77 (66–89) | 0.39 (0.16–0.95) | ||
II | 69 (22.3) | 46 (36–55) | 1.10 (0.51–2.38) | ||
III | 112 (36.1) | 36 (28–44) | 1.73 (0.84–3.57) | ||
IV | 35 (11.3) | 13 (9–17) | 4.16 (1.87–9.28) | ||
Resection status [n (%)] | <0.001 | 0.052 | |||
R0 | 285 (91.9) | 51 (45–57) | - | ||
R1 | 8 (7.7) | 20 (10–30) | 1.83 (0.99–3.37) | ||
R2 | 1 (0.3) | 1 (1–1) | - | ||
Clavien–Dindo Classification [n (%)] | <0.001 | 0.001 | |||
I–IIIa | 175 (56.5) | 65 (57–72) | - | ||
IIIb–IVb | 90 (29) | 36 (28–43) | 1.84 (1.27–2.67) |
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Kemper, M.; Zagorski, J.; Wagner, J.; Graß, J.-K.; Izbicki, J.R.; Melling, N.; Wolter, S.; Reeh, M. Socioeconomic Deprivation Is Not Associated with Outcomes after Esophagectomy at a German High-Volume Center. Cancers 2023, 15, 2827. https://doi.org/10.3390/cancers15102827
Kemper M, Zagorski J, Wagner J, Graß J-K, Izbicki JR, Melling N, Wolter S, Reeh M. Socioeconomic Deprivation Is Not Associated with Outcomes after Esophagectomy at a German High-Volume Center. Cancers. 2023; 15(10):2827. https://doi.org/10.3390/cancers15102827
Chicago/Turabian StyleKemper, Marius, Jana Zagorski, Jonas Wagner, Julia-Kristin Graß, Jakob R. Izbicki, Nathaniel Melling, Stefan Wolter, and Matthias Reeh. 2023. "Socioeconomic Deprivation Is Not Associated with Outcomes after Esophagectomy at a German High-Volume Center" Cancers 15, no. 10: 2827. https://doi.org/10.3390/cancers15102827