INTRODUCTION Esophageal squamous cell carcinoma (ESCC) has a higher incidence and prevalence than esophageal adenocarcinoma amongst Black individuals in the United States. Black individuals have lower ESCC survival. These racial disparities have not been thoroughly investigated. We examined the disparity in treatment and survival stratified by ESCC stage at diagnosis. METHODS The Surveillance, Epidemiology, and End Results database was queried to identify patients with ESCC between 2000-2019. The identified cohort was divided into subgroups by race. Patient and cancer characteristics, treatment received, and survival rates were compared across the racial subgroups. RESULTS A total of 23,768 patients with ESCC were identified. Compared with White individuals, Black individuals were younger and had more distant disease at the time of diagnosis (distant disease: 26.7% vs. 23.8%, p<0.001). Black individuals had lower age-standardized 5-year survival for localized (Survival % [95% CI]: 19.3 [16 - 22.8] vs. 27.6 [25.1 - 30.2]), regional (14.3 [12 - 16.7] vs. 21.1 [19.6 - 22.7]), and distant (2.9 [1.9 - 4.1] vs. 6.5 [5.5 - 7.5]) disease. Black individuals were less likely to receive chemotherapy (54.7% vs. 57.5%, p=0.001), radiation (58.5% vs. 60.4%, p=0.03), and surgery (11.4% vs 16.3%, p<0.0001). CONCLUSION Black individuals with ESCC have a lower survival than White individuals. This could be related to presenting at a later stage, but also disparities in which treatments they receive even among individuals with the same stage of disease. To what extent these disparities in receipt of treatment is due to structural racism, social determinants of health, implicit bias, or patient preferences deserves further study.

中文翻译：

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美国食管鳞状细胞癌治疗和生存的种族差异。

简介 在美国黑人中，食管鳞状细胞癌 (ESCC) 的发病率和患病率高于食管腺癌。黑人的食管鳞癌存活率较低。这些种族差异尚未得到彻底调查。我们检查了诊断时按 ESCC 分期分层的治疗和生存差异。方法 查询监测、流行病学和最终结果数据库，以确定 2000 年至 2019 年期间患有 ESCC 的患者。确定的队列按种族分为亚组。比较不同种族亚组的患者和癌症特征、接受的治疗和生存率。结果 总共确定了 23,768 名 ESCC 患者。与白人相比，黑人在诊断时更年轻，患有更远的疾病（远距离疾病：26.7% vs. 23.8%，p<0.001）。黑人个体的局部（生存％[95% CI]：19.3 [16 - 22.8] vs. 27.6 [25.1 - 30.2]）、区域（14.3 [12 - 16.7] vs. 21.1 [ 19.6 - 22.7]）和远处（2.9 [1.9 - 4.1] vs. 6.5 [5.5 - 7.5]）疾病。黑人接受化疗（54.7% vs. 57.5%，p=0.001）、放疗（58.5% vs. 60.4%，p=0.03）和手术（11.4% vs 16.3%，p<0.0001）的可能性较小。结论 患有 ESCC 的黑人的存活率低于白人。这可能与发病较晚有关，而且与处于同一疾病阶段的个体之间接受的治疗也存在差异有关。这些接受治疗的差异在多大程度上是由于结构性种族主义、健康的社会决定因素、隐性偏见或患者偏好造成的，值得进一步研究。