Long Beverly, Chang Jenny, Ziogas Argyrios, Tewari Krishnansu S, Anton-Culver Hoda, Bristow Robert E
Department of Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA.
Department of Epidemiology, University of California, Irvine, Irvine, CA.
Am J Obstet Gynecol. 2015 Apr;212(4):468.e1-9. doi: 10.1016/j.ajog.2014.10.1104. Epub 2014 Oct 31.
We sought to investigate the impact of race, socioeconomic status (SES), and health care system characteristics on receipt of specific components of National Comprehensive Cancer Network guideline care for stage IIIC/IV ovarian cancer.
Patients diagnosed with stage IIIC/IV epithelial ovarian cancer between Jan. 1, 1996, through Dec. 31, 2006, were identified from the California Cancer Registry. Multivariate logistic regression analyses evaluated differences in surgery, chemotherapy, and treatment sequence according to race, increasing SES (SES-1 to SES-5), and provider annual case volume.
A total of 11,865 patients were identified. Median age at diagnosis was 65.0 years. The overall median cancer-specific survival was 28.2 months. African American race (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.45-2.87) and care by a low-volume physician (OR, 19.72; 95% CI, 11.87-32.77) predicted an increased risk of not undergoing surgery. Patients with SES-1 (OR, 0.71; 95% CI, 0.60-0.85) and those treated at low-volume hospitals (OR, 0.88; 95% CI, 0.77-0.99) or by low-volume physicians (OR, 0.80; 95% CI, 0.70-0.92) were less likely to undergo debulking surgery. African American race (OR, 1.55; 95% CI, 1.24-1.93) and SES-1 (OR, 1.80; 95% CI, 1.35-2.39) were both significant predictors of not receiving chemotherapy. African American patients were also more likely than whites to receive no treatment (OR, 2.08; 95% CI, 1.45-2.99) or only chemotherapy (OR, 1.55; 95% CI, 1.10-2.18). Patients with low SES were more likely to receive no treatment (OR, 1.95; 95% CI, 1.44-2.64) or surgery without chemotherapy (OR, 1.67; 95% CI, 1.38-2.03).
Among patients with advanced-stage ovarian cancer, African American race, low SES, and treatment by low-volume providers are significant and independent predictors of receiving no surgery, no debulking surgery, no chemotherapy, and nonstandard treatment sequences.
我们试图研究种族、社会经济地位（SES）和医疗保健系统特征对接受美国国立综合癌症网络（National Comprehensive Cancer Network）IIIC/IV期卵巢癌指南特定治疗方案的影响。
从加利福尼亚癌症登记处识别出1996年1月1日至2006年12月31日期间被诊断为IIIC/IV期上皮性卵巢癌的患者。多因素逻辑回归分析评估了根据种族、SES升高（SES-1至SES-5）和医生年度病例量在手术、化疗及治疗顺序方面的差异。
共识别出11865例患者。诊断时的中位年龄为65.0岁。总体癌症特异性生存的中位时间为28.2个月。非裔美国人种族（比值比[OR]，2.04；95%置信区间[CI]，1.45 - 2.87）以及由低病例量医生治疗（OR，19.72；95% CI，11.87 - 32.77）预示未接受手术的风险增加。SES-1级别的患者（OR，0.71；95% CI，0.60 - 0.85）以及在低病例量医院接受治疗的患者（OR，0.88；95% CI，0.77 - 0.99）或由低病例量医生治疗的患者（OR，0.80；95% CI，0.70 - 0.92）接受肿瘤细胞减灭术的可能性较小。非裔美国人种族（OR，1.55；95% CI，1.24 - 1.93）和SES-1（OR，1.80；95% CI，1.35 - 2.39）均为未接受化疗的显著预测因素。非裔美国患者比白人更有可能未接受任何治疗（OR，2.08；95% CI，1.45 - 2.99）或仅接受化疗（OR，1.55；95% CI，1.10 - 2.18）。SES较低的患者更有可能未接受任何治疗（OR，1.95；95% CI，1.44 - 2.64）或接受手术但未接受化疗（OR，1.67；95% CI，1.38 - 2.03）。
在晚期卵巢癌患者中，非裔美国人种族、低SES以及由低病例量医疗服务提供者进行治疗是未接受手术、未接受肿瘤细胞减灭术、未接受化疗以及非标准治疗顺序的显著且独立的预测因素。
