Division of Epidemiology, Ohio State University College of Public Health, Columbus, OH.
Division of Cancer Prevention and Control, Ohio State University College of Medicine, Columbus, OH.
Int J Cancer. 2018 Mar 15;142(6):1102-1115. doi: 10.1002/ijc.31127. Epub 2017 Nov 6.
Non-Hispanic black (NHB) women are more likely to experience an endometrial carcinoma (EC) recurrence compared to non-Hispanic white (NHW) women. The extent to which tumor characteristics, socioeconomic status (SES) and treatment contribute to this observation is not well defined. In the NRG Oncology/Gynecology Oncology Group (GOG) 210 Study we evaluated associations between race/ethnicity and EC recurrence according to tumor characteristics with adjustment for potential confounders. Our analysis included 3,199 NHW, 532 NHB and 232 Hispanic women with EC. Recurrence was documented during follow-up. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between race/ethnicity and EC recurrence in models stratified by histologic subtype (low-grade endometrioid, high-grade endometrioid, serous, mixed cell, carcinosarcoma, clear cell) or stage (I, II, III) and adjusted for age, SES, body mass index, smoking status and treatment. In histologic subtype-stratified models, higher EC recurrence was noted in NHB women with low-grade endometrioid (HR = 1.94, 95% CI = 1.21-3.10) or carcinosarcomas (HR = 1.66, 95% CI = 0.99-2.79) compared to NHWs. In stage-stratified models, higher EC recurrence was noted among NHB women with stage I (HR = 1.48, 95% CI = 1.06-2.05) and Hispanic women with stage III disease (HR = 1.81, 95% CI = 1.11-2.95). Our observations of higher EC recurrence risk among NHB and Hispanic women, as compared to NHW women, were not explained by tumor characteristics, SES, treatment or other confounders. Other factors, such as racial differences in tumor biology or other patient factors, should be explored as contributors to racial disparities in EC recurrence.
非西班牙裔黑人(NHB)女性比非西班牙裔白人(NHW)女性更容易出现子宫内膜癌(EC)复发。肿瘤特征、社会经济地位(SES)和治疗在多大程度上导致了这一观察结果尚不清楚。在 NRG Oncology/Gynecology Oncology Group(GOG)210 研究中,我们根据肿瘤特征评估了种族/民族与 EC 复发之间的关联,并调整了潜在混杂因素。我们的分析包括 3199 名 NHW、532 名 NHB 和 232 名西班牙裔 EC 女性。在随访期间记录了复发情况。我们使用 Cox 回归估计了种族/民族与 EC 复发之间的风险比(HRs)和 95%置信区间(CIs),这些关联在组织学亚型(低级别子宫内膜样、高级别子宫内膜样、浆液性、混合细胞、癌肉瘤、透明细胞)或分期(I、II、III)分层的模型中进行,调整了年龄、SES、体重指数、吸烟状况和治疗。在组织学亚型分层模型中,与 NHW 女性相比,患有低级别子宫内膜样癌(HR=1.94,95%CI=1.21-3.10)或癌肉瘤(HR=1.66,95%CI=0.99-2.79)的 NHB 女性 EC 复发率更高。在分期分层模型中,与 NHW 女性相比,患有 I 期疾病的 NHB 女性(HR=1.48,95%CI=1.06-2.05)和患有 III 期疾病的西班牙裔女性(HR=1.81,95%CI=1.11-2.95)EC 复发风险更高。与 NHW 女性相比,我们观察到 NHB 和西班牙裔女性 EC 复发风险更高,这不能用肿瘤特征、SES、治疗或其他混杂因素来解释。应探索肿瘤生物学或其他患者因素等其他因素,作为 EC 复发种族差异的促成因素。