Rauh-Hain J Alejandro, Buskwofie Ama, Clemmer Joel, Boruta David M, Schorge John O, Del Carmen Marcela G
Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Obstet Gynecol. 2015 Apr;125(4):843-851. doi: 10.1097/AOG.0000000000000605.
To examine the patterns of care and survival for African American and white women with high-grade endometrial cancer.
The linked Surveillance, Epidemiology, and End Results and Medicare databases were queried to identify patients diagnosed with grade 3 endometrioid endometrial adenocarcinoma, uterine carcinosarcoma, uterine clear cell carcinoma, and uterine serous carcinoma between 1992 and 2009. The effect of treatment modality on survival was analyzed using the Kaplan-Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model.
A total of 9,042 patients met study eligibility criteria. African Americans had definitive surgery (76.8% compared with 88.7%; P<.001) less frequently. There was no difference in the rate of adjuvant treatment between the groups. In the crude models for both all-cause mortality and cancer-specific mortality, African American women had an increased overall and disease-specific hazard of death compared with white women. The overall hazard ratio for African American women was 1.6 (95% confidence interval [CI] 1.5-1.7), and the disease-specific hazard ratio was 1.5 (95% CI 1.3-1.6). Over the entire study period, after adjusting for stage, age, period of diagnosis, registry region, urban compared with rural setting, marital status, treatment, surgery, socioeconomic status, and comorbidities, there was no association between race and lower disease-specific survival (hazard ratio 1.1, 95% CI 1-1.2; P=.06).
African American women had lower cancer-specific and all-cause survival compared with white women. Controlling for treatment, sociodemographics, comorbidities, and histopathologic variables eliminated the difference between African American and white women in the disease-specific analysis.
研究患有高级别子宫内膜癌的非裔美国女性和白人女性的治疗模式及生存率。
查询关联的监测、流行病学及最终结果数据库和医疗保险数据库，以识别1992年至2009年间被诊断为3级子宫内膜样腺癌、子宫肉瘤、子宫透明细胞癌和子宫浆液性癌的患者。使用Kaplan-Meier方法分析治疗方式对生存率的影响。采用Cox比例风险模型比较预测结果的因素。
共有9042名患者符合研究纳入标准。非裔美国人接受根治性手术的频率较低（76.8%，而白人女性为88.7%；P<0.001）。两组之间辅助治疗的比例没有差异。在全因死亡率和癌症特异性死亡率的粗模型中，与白人女性相比，非裔美国女性的总体和疾病特异性死亡风险增加。非裔美国女性的总体风险比为1.6（95%置信区间[CI]1.5-1.7），疾病特异性风险比为1.5（95%CI 1.3-1.6）。在整个研究期间，在调整了分期、年龄、诊断时期、登记地区、城市与农村环境、婚姻状况、治疗、手术、社会经济地位和合并症后，种族与较低的疾病特异性生存率之间没有关联（风险比1.1，95%CI 1-1.2；P=0.06）。
与白人女性相比，非裔美国女性的癌症特异性和全因生存率较低。在控制治疗、社会人口统计学、合并症和组织病理学变量后，非裔美国女性和白人女性在疾病特异性分析中的差异消失。
