O'Malley Cynthia D, Cress Rosemary D, Campleman Sharan L, Leiserowitz Gary S
Northern California Cancer Center, Union City, CA 94587, USA.
Gynecol Oncol. 2003 Dec;91(3):608-15. doi: 10.1016/j.ygyno.2003.08.010.
The objective was to identify demographic, clinical, and provider characteristics that might influence cancer survival in a cohort of Northern California women using a population-based cancer registry.
We used California Cancer Registry data to evaluate survival in 1051 Northern California women who were diagnosed with epithelial ovarian cancer between 1994 and 1996 and underwent a surgical procedure for their cancer. Chemotherapy data from the cancer registry were supplemented with a physician survey and medical record review. Database linkages with census and hospital discharge data provided socioeconomic and comorbidity measures. Kaplan-Meier method was used to generate survival curves and multivariate Cox proportional hazard models were used to evaluate the effect of different factors on survival.
Crude 5-year survival was 82, 57, 28, and 10% for women with FIGO stage IC, II, III, and IV disease, respectively. Adverse survival was most strongly influenced by advanced stages III and IV with a hazards ratio ranging from 8 to 11.8 compared to stage IC disease. Multivariate analysis also identified other adverse factors including high grade and other adverse histologies, age over 45, and rural location. Chemotherapy decreased the risk of death by 50% if the patient had advanced-stage disease. Medical comorbidity increased the risk of death by 40%. Survival was not influenced by race/ethnicity, socioeconomic status, physician specialty, or hospital characteristics.
Advanced age remains an adverse prognostic factor even after adjustment for treatment and comorbidity factors. These results also suggest that there may be important regional differences in ovarian cancer survival.
利用基于人群的癌症登记系统，确定可能影响北加利福尼亚州一组女性癌症生存率的人口统计学、临床和医疗服务提供者特征。
我们使用加利福尼亚癌症登记数据，评估了1994年至1996年间被诊断为上皮性卵巢癌并接受了癌症手术的1051名北加利福尼亚州女性的生存率。癌症登记处的化疗数据通过医生调查和病历审查得到补充。与人口普查和医院出院数据的数据库链接提供了社会经济和合并症指标。采用Kaplan-Meier方法生成生存曲线，并使用多变量Cox比例风险模型评估不同因素对生存的影响。
国际妇产科联盟（FIGO）分期为IC、II、III和IV期疾病的女性，其5年粗生存率分别为82%、57%、28%和10%。与IC期疾病相比，III期和IV期晚期疾病对不良生存的影响最为显著，风险比在8至11.8之间。多变量分析还确定了其他不良因素，包括高级别和其他不良组织学类型、45岁以上年龄以及农村地区。如果患者患有晚期疾病，化疗可使死亡风险降低50%。医疗合并症使死亡风险增加40%。生存率不受种族/民族、社会经济地位、医生专业或医院特征的影响。
即使在调整治疗和合并症因素后，高龄仍然是一个不良预后因素。这些结果还表明，卵巢癌生存率可能存在重要的地区差异。
