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子宫浆液性癌患者生存的种族差异:1988年至2011年临床特征、治疗模式及结局随时间的变化

Racial disparity in survival of patients with uterine serous carcinoma: Changes in clinical characteristics, patterns of care and outcomes over time from 1988 to 2011.

作者信息

Mahdi Haider, Han Xiaozhen, Abdul-Karim Fadi, Vargas Roberto

机构信息

Gynecologic Oncology Division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.

Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH, USA.

出版信息

Gynecol Oncol. 2016 Nov;143(2):334-345. doi: 10.1016/j.ygyno.2016.03.002. Epub 2016 Aug 26.

Abstract

OBJECTIVES

To determine if the disparities in the outcome between white (W) and African American (AA) patients with uterine serous carcinoma (USC) have changed over time.

METHODS

Women with USC were identified using the SEER database from 1988 to 2011 (N=7667). Years of the study were divided into three periods (1988-1997, 1998-2004 and 2005-2011). Overall (OS) and disease-specific survivals (DSS) was estimated.

RESULTS

Over the three time periods, African American patients continued to be younger and less likely to have cancer directed surgery and extensive lymphadenectomy when compared to white patients. In multivariable analysis adjusting for age, race, marital status, stage, cancer-directed surgery, extent of lymphadenectomy, adjuvant radiation, and geographic location, AA was significantly associated with worse DSS and OS in the three time periods compared to white race. African American patients were 29% (95% CI 1.03-1.62, p=0.027) in 1988-1997, 40% in 1998-2004 (95% CI 1.21-1.63, p<0.0001) and 34% in 2005-2011 (95% CI 1.13-1.59, p=0.0008) more likely to die from uterine cancer compared to their white counterparts. A slight improvement in the difference in OS over time was noted comparing African American and white patients. African American patients were 46% (95% CI 1.23-1.73, p<0.0001) in 1988-1997, 39% in 1998-2004 (95% CI 1.23-1.56, p<0.0001) and 26% in 2005-2011 (95% CI 1.10-1.45, p<0.0001) more likely to die from any cause compared to their white counterparts.

CONCLUSIONS

Significant improvement in outcome was noted in both racial groups over time. However, African American patients continued to have worse outcome than white patients over time.

摘要

目的

确定白人(W)和非裔美国(AA)子宫浆液性癌(USC)患者的预后差异是否随时间变化。

方法

利用监测、流行病学和最终结果(SEER)数据库识别出1988年至2011年期间的USC女性患者(N = 7667)。研究年份分为三个时期(1988 - 1997年、1998 - 2004年和2005 - 2011年)。估计总体生存率(OS)和疾病特异性生存率(DSS)。

结果

在这三个时间段内,与白人患者相比,非裔美国患者年龄更小,接受癌症定向手术和广泛淋巴结清扫术的可能性更低。在对年龄、种族、婚姻状况、分期、癌症定向手术、淋巴结清扫范围、辅助放疗和地理位置进行多变量分析时,与白人种族相比,非裔美国人在这三个时间段内的DSS和OS均显著较差。与白人患者相比,1988 - 1997年非裔美国患者死于子宫癌的可能性高29%(95%CI 1.03 - 1.62,p = 0.027),1998 - 2004年高40%(95%CI 1.21 - 1.63,p < 0.0001),2005 - 2011年高34%(95%CI 1.13 - 1.59,p = 0.0008)。比较非裔美国人和白人患者发现,随着时间推移,OS差异略有改善。与白人患者相比,1988 - 1997年非裔美国患者因任何原因死亡的可能性高46%(95%CI 1.23 - 1.73,p < 0.0001),1998 - 2004年高39%(95%CI 1.23 - 1.56,p < 0.0001),2005 - 2011年高26%(95%CI 1.10 - 1.45,p < 0.0001)。

结论

随着时间推移,两个种族组的预后均有显著改善。然而,随着时间推移,非裔美国患者的预后仍比白人患者差。

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