Bryant Christopher S, Kumar Sanjeev, Shah Jay P, Mahdi Haider, Ali-Fehmi Rouba, Munkarah Adnan R, Deppe Gunter, Morris Robert T
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Wayne State University School of Medicine, Detroit, MI, USA.
Gynecol Oncol. 2009 Sep;114(3):437-41. doi: 10.1016/j.ygyno.2009.05.039. Epub 2009 Jun 26.
OBJECTIVE(S): To compare the survival of African American (AA) and white (W) patients with malignant germ cell tumors of the ovary (OGCT).
Patients with a diagnosis of OGCT were identified from Surveillance, Epidemiology, and End Results Program (SEER) from 1988 to 2004, and were divided into African American (AA) and white (W) subgroups. Only surgically treated patients were included. Histology was grouped into dysgerminoma (D), malignant teratoma (MT), and mixed germ cell tumors with pure non-dysgerminoma cell tumors (MGCT/PNDCT). Statistical analysis using Chi-square, Fisher's Exact Test, Kaplan-Meier survival methods, and Cox regression proportional hazards were performed.
In 1110 patients with OGCT, 970 (87.4%) were W and 140 (12.6%) were AA. MGCT/PNDCT histology was equally represented in AA and W. However, W were twice as likely to present with D (W 34% vs. AA 16%, p<0.01) and 1.5 times less likely to present with MT (W 41% vs. AA 59%, p<0.01). The majority (W 64%, AA 64%) of OGCT were stage I. Advanced stage (FIGO III and IV) tumors were more prominent in AA (24% vs. 18%, p>0.05). Complete surgical staging effort was utilized more frequently in W (49%) as compared to AA (38%; p=0.001). Overall 5-year survival was 92% for W and 86% for AA (p=0.02). In multivariate analysis race was not an independent predictor of survival when histology, stage and surgical staging were controlled.
CONCLUSION(S): In our study, a higher prevalence of complete surgical staging and a favorable distribution of low risk histologic types may explain the improved survival observed in white patients with OGCT. However, race was not an independent predictor of survival.
比较非裔美国（AA）和白人（W）卵巢恶性生殖细胞肿瘤（OGCT）患者的生存率。
从1988年至2004年的监测、流行病学和最终结果计划（SEER）中确定诊断为OGCT的患者，并分为非裔美国（AA）和白人（W）亚组。仅纳入接受手术治疗的患者。组织学分为无性细胞瘤（D）、恶性畸胎瘤（MT）以及伴有纯非无性细胞瘤成分的混合性生殖细胞肿瘤（MGCT/PNDCT）。采用卡方检验、Fisher精确检验、Kaplan-Meier生存方法和Cox回归比例风险模型进行统计分析。
在1110例OGCT患者中，970例（87.4%）为白人，140例（12.6%）为非裔美国人。MGCT/PNDCT组织学类型在非裔美国人和白人中所占比例相同。然而，白人出现无性细胞瘤的可能性是黑人的两倍（白人34%对非裔美国人16%，p<0.01），出现恶性畸胎瘤的可能性比非裔美国人少1.5倍（白人41%对非裔美国人59%，p<0.01）。大多数OGCT（白人64%，非裔美国人64%）为I期。晚期（FIGO III和IV期）肿瘤在非裔美国人中更为突出（24%对18%，p>0.05）。与非裔美国人（38%；p=0.001）相比，白人（49%）更频繁地采用完整的手术分期。白人的总体5年生存率为92%，非裔美国人为86%（p=0.02）。在多变量分析中，当控制组织学、分期和手术分期时，种族不是生存的独立预测因素。
在我们的研究中，完整手术分期的较高患病率以及低风险组织学类型的有利分布可能解释了白人OGCT患者生存率的提高。然而，种族不是生存的独立预测因素。
