Coker Ann L, Du Xianglin L, Fang Shenying, Eggleston Katherine S
School of Public Health, University of Texas, 1200 Herman Pressler, PO Box 20186, Houston, TX 77225, USA.
Gynecol Oncol. 2006 Aug;102(2):278-84. doi: 10.1016/j.ygyno.2005.12.016. Epub 2006 Jan 24.
Tumor stage, age, and cell type are well-characterized predictors for cervical cancer survival; socioeconomic factors may also play an important role. The purpose of this study is to estimate cervical cancer survival by socioeconomic indicators and race/ethnicity among elderly women diagnosed with cervical cancer.
We studied 1251 women with cervical cancer aged 65 or older, identified between 1992 and 1999 from the Surveillance, Epidemiology, and End Results [SEER]-Medicare linked data. All women had similar access to care through Medicare fee-for-services insurance. A composite measure of socioeconomic status was created using census tract level data for poverty, education, and income. Cox proportional hazard modeling was used for all-cause and cervical cancer-specific survival analysis.
Increased age (P < 0.0001) and advanced tumor stage (<0.0001) were associated with poorer all-cause and cervical cancer-specific survival. After adjustment for age, stage, and treatment, increased co-morbidity scores and having non-squamous cervical cancer were associated with poorer all-cause survival (P < 0.001). After adjusting for confounders, women receiving hysterectomy vs. no surgery or any treatment had significantly better all-cause and cervical cancer-specific survival. Socioeconomic factors were not associated with either all-cause (P for trend = 0.79) or cervical cancer-specific (P for trend = 0.81) survival. No racial/ethnic differences in all-cause or cervical cancer-specific survival were observed after adjusting for socioeconomic factors.
Among women with similar access to care, neither minority race/ethnicity nor poorer socioeconomic status were associated with poorer survival in this large sample of older women diagnosed with invasive cervical cancer. Presence of co-morbid conditions and treatment were important predictors of cervical cancer survival.
肿瘤分期、年龄和细胞类型是宫颈癌生存情况的典型预测指标；社会经济因素可能也起着重要作用。本研究的目的是通过社会经济指标以及种族/民族来评估老年宫颈癌女性患者的生存情况。
我们研究了1251名年龄在65岁及以上的宫颈癌女性患者，这些患者是在1992年至1999年期间从监测、流行病学和最终结果（SEER）与医疗保险的关联数据中识别出来的。所有女性通过医疗保险按服务付费保险获得相似的医疗服务。利用人口普查区层面的贫困、教育和收入数据创建了社会经济地位的综合指标。采用Cox比例风险模型进行全因生存分析和宫颈癌特异性生存分析。
年龄增加（P < 0.0001）和肿瘤分期较晚（P < 0.0001）与全因生存和宫颈癌特异性生存较差相关。在调整年龄、分期和治疗因素后，合并症评分增加以及患有非鳞状宫颈癌与全因生存较差相关（P < 0.001）。在调整混杂因素后，接受子宫切除术的女性与未接受手术或任何治疗的女性相比，全因生存和宫颈癌特异性生存显著更好。社会经济因素与全因生存（趋势P = 0.79）或宫颈癌特异性生存（趋势P = 0.81）均无关联。在调整社会经济因素后，未观察到全因生存或宫颈癌特异性生存方面的种族/民族差异。
在获得相似医疗服务的女性中，在这个被诊断为浸润性宫颈癌的老年女性大样本中，少数族裔种族/民族或较差的社会经济地位均与较差的生存情况无关。合并症的存在和治疗是宫颈癌生存的重要预测因素。
