Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, CA 92868, USA.
Gynecol Oncol. 2011 Aug;122(2):319-23. doi: 10.1016/j.ygyno.2011.04.047. Epub 2011 May 31.
To examine disparities in delivery of care and survival according to racial classification among White and African-American women with Stage IIIC epithelial ovarian cancer undergoing initial treatment in a tertiary referral center setting.
All consecutive patients diagnosed with Stage IIIC epithelial ovarian cancer between 1/1/95 and 12/31/08 were identified and clinic-pathologic variables retrospectively collected. Differences in initial treatment paradigm, surgical and adjuvant therapy, and overall survival according to racial classification were assessed by univariate and multivariate analyses.
A total of 405 patients (White, n=366; African-American, n=39) were identified. There were no significant differences according to racial classification in age, CA125, ASA class, histology, tumor grade, the frequency of initial surgery (90.4% vs 82.1%, p=0.06), optimal residual disease (73.0% vs 69.2%, p=0.28), no gross residual disease (51.4% vs 53.8%, p=0.49), and platinum-taxane chemotherapy (88.3% vs 87.2%, p=0.55). The median overall survival for White patients was 50.5 months (95%CI=43.2-57.9 months), compared to 47.0 (95%CI=36.2-57.8) months for African-Americans (p=0.57). On multivariate analysis, age, tumor grade 3, serum albumin <3.0 g/dl, platinum-based chemotherapy, and no gross residual disease were independently associated with overall survival, while African-American race was not (HR=1.06, 95%CI=0.61-1.79).
Among women undergoing initial treatment for ovarian cancer at a tertiary referral center, African-American patients were as likely as White patients to undergo cytoreductive surgery, be left with minimal post-surgical residual disease, and receive appropriate chemotherapy. With equal access to gynecologic oncology care and multidisciplinary cancer resources, the survival disparities according to race observed in population-based studies are largely mitigated.
在一家三级转诊中心，对接受初始治疗的白人及非裔美国 IIIC 期上皮性卵巢癌患者，根据种族分类，研究医疗护理及生存方面的差异。
1995 年 1 月 1 日至 2008 年 12 月 31 日，连续确诊为 IIIC 期上皮性卵巢癌的所有患者，均被识别并回顾性收集临床病理变量。通过单变量和多变量分析，评估种族分类对初始治疗模式、手术和辅助治疗以及总体生存率的影响。
共确定了 405 名患者（白人，n=366；非裔美国人，n=39）。非裔美国人与白人患者在年龄、CA125、ASA 分级、组织学、肿瘤分级、初始手术的频率（90.4% vs 82.1%，p=0.06）、最佳残余疾病（73.0% vs 69.2%，p=0.28）、无肉眼残留疾病（51.4% vs 53.8%，p=0.49）和铂类联合紫杉烷化疗（88.3% vs 87.2%，p=0.55）方面，均无显著差异。白人患者的中位总生存时间为 50.5 个月（95%CI=43.2-57.9 个月），而非裔美国人患者的中位总生存时间为 47.0 个月（95%CI=36.2-57.8 个月）（p=0.57）。多变量分析显示，年龄、肿瘤分级 3 级、血清白蛋白<3.0 g/dl、铂类为基础的化疗和无肉眼残留疾病是与总生存相关的独立因素，而非裔美国人种族并非独立因素（HR=1.06，95%CI=0.61-1.79）。
在一家三级转诊中心接受卵巢癌初始治疗的患者中，非裔美国患者与白人患者一样，可能接受细胞减灭术，术后残留疾病最小化，并接受适当的化疗。在获得妇科肿瘤学护理和多学科癌症资源方面机会均等的情况下，人群研究中观察到的种族差异导致的生存差异在很大程度上得到缓解。
