种族和伴侣状况对早期宫颈癌年轻女性的治疗模式和生存的影响。

The impact of race and partner status on patterns of care and survival in young women with early-stage cervical cancer.

机构信息

Department of Radiation, Perelman School of Medicine, University of Pennsylvania, PA 19104, USA.

出版信息

Int J Gynecol Cancer. 2013 Mar;23(3):494-9. doi: 10.1097/IGC.0b013e318280824d.

DOI:10.1097/IGC.0b013e318280824d

PMID:23388613

Abstract

OBJECTIVES

Although outcomes for surgery versus radiotherapy (RT) for stage IB patients are similar, young women are often preferentially treated with surgery rather than RT. Adjuvant RT is indicated for high-risk patients after surgery. Our goal was to study the impact of race and partner status on patterns of care of young women with stage I cervical cancer.

METHODS

We identified a cohort of 6586 women, aged 15 to 39 years, in the Surveillance, Epidemiology and End Results database diagnosed with stage I cervical cancer between 1988 and 2007.

RESULTS

In our cohort, 93% (n = 5080) of white women had surgery, and 86.5% (n = 985) of nonwhite women had surgery as primary treatment. On multivariate analysis, higher FIGO (International Federation of Gynecology and Obstetrics) stage (IA2 odds ratio [OR] 3.09 [P = 0.01]; IB OR, 21.41 [P < 0.001]), widowed/single (OR, 1.39; P = 0.02), squamous histology (OR, 1.69; P < 0.001), diagnosis during 1993-1997 time period (OR, 1.69; P < 0.001), and nonwhite race (OR, 1.95; P ≤ 0.001) were more likely to receive RT as primary treatment. Of the surgical patients, 15.45% of white women versus 20.4% in the nonwhite women (P < 0.001) had high-risk disease, and 66% of the white women versus 71% of the nonwhite women received adjuvant RT (P = 0.136). Race and marital status were not significant predictors of receiving adjuvant RT on multivariate analysis. Predictors of worse overall survival included RT as primary treatment (hazard ratio [HR], 1.89; P < 0.001) and nonwhite race (HR, 1.6; P = 0.001). Marital status was not a significant predictor of overall survival. Race was a significant predictor of survival for women who received surgery as primary treatment (nonwhite HR, 1.93; P < 0.001).

CONCLUSIONS

Nonwhites are more likely than whites to have RT as primary treatment. This suggests that nonwhite women may have social/cultural barriers impacting their treatment decision making or may have a higher likelihood of other comorbidities that limit their surgical options.

摘要

目的

尽管手术与放疗（RT）治疗 IB 期患者的结果相似，但年轻女性通常更倾向于接受手术而不是 RT。手术后高危患者需要辅助 RT。我们的目标是研究种族和伴侣状况对年轻宫颈癌 I 期患者治疗模式的影响。

方法

我们在监测、流行病学和最终结果数据库中确定了 1988 年至 2007 年间诊断为宫颈癌 I 期的 6586 名年龄在 15 至 39 岁的女性队列。

结果

在我们的队列中，93%（n=5080）的白人女性接受了手术，86.5%（n=985）的非白人女性接受了手术作为主要治疗方法。多变量分析显示，FIGO（国际妇产科联合会）分期较高（IA2 比值比 [OR] 3.09 [P=0.01]；IB OR，21.41 [P<0.001]）、丧偶/单身（OR，1.39；P=0.02）、鳞状组织学（OR，1.69；P<0.001）、诊断于 1993-1997 年期间（OR，1.69；P<0.001）和非白人种族（OR，1.95；P≤0.001）更有可能接受 RT 作为主要治疗方法。在接受手术的患者中，15.45%的白人女性与非白人女性（P<0.001）中 20.4%的患者存在高危疾病，而接受辅助 RT 的白人女性占 66%，而非白人女性占 71%（P=0.136）。多变量分析显示，种族和婚姻状况并不是接受辅助 RT 的显著预测因素。总生存的预测因素包括 RT 作为主要治疗方法（危险比 [HR]，1.89；P<0.001）和非白人种族（HR，1.6；P=0.001）。婚姻状况不是总生存的显著预测因素。对于接受手术作为主要治疗方法的女性，种族是生存的显著预测因素（非白人 HR，1.93；P<0.001）。