考虑竞争风险的亚洲和美国白种人宫颈癌患者的预后因素。
Prognostic factors in Asian and white American patients with cervical cancer, considering competing risks.
机构信息
Department of Statistics, College of Economics, Jinan University, Guangzhou, P.R.C.
Department of Biostatistics, School of Public Health, Guangdong Provincial Key Laboratory of Tropical Disease Research, Southern Medical University, Guangzhou, P.R.C.
出版信息
Curr Oncol. 2019 Jun;26(3):e277-e285. doi: 10.3747/co.26.4473. Epub 2019 Jun 1.
BACKGROUND
Cervical cancer is the 2nd most common malignant tumour in women worldwide. Previous research studies have given little attention to its prognostic factors in the rapidly growing Asian American population. In the present study, we explored prognostic factors in Asian and white American patients with cervical cancer, considering competing risks.
METHODS
The study included 58,780 patients with cervical cancer, of whom 54,827 were white and 3953 were Asian American, and for all of whom complete clinical information was available in the U.S. Surveillance, Epidemiology, and End Results database. Death from cervical cancer was considered to be the event of interest, and deaths from other causes were defined as competing risks. The cumulative incidence function and the Fine-Gray method were applied for univariate and multivariate analysis respectively.
RESULTS
We found that, for all patients (white and Asian American combined), the cumulative incidence function was associated with several factors, such as age at diagnosis, figo (Fédération internationale de Gynécologie et d'Obstétrique) stage, registry area, and lymph node metastasis. Similar results were found when considering white patients only. However, for Asian American patients, registry area was not associated with the cumulative incidence function, but the other factors (for example, figo stage) remained statistically significant. Similarly, in multivariate analyses, we found that age at diagnosis, figo stage, lymph node metastasis, tumour histology, treatment method, and race were all associated with prognosis.
CONCLUSIONS
Survival status differs for white and Asian American patients with cervical cancer. Our results could guide the treatment of, and facilitate prognostic judgments about, white and Asian American patients with cervical cancer.
背景
宫颈癌是全球女性中第二大常见的恶性肿瘤。以前的研究很少关注快速增长的亚裔美国人群中的宫颈癌预后因素。在本研究中，我们探讨了亚裔和白种美国宫颈癌患者的预后因素，同时考虑了竞争风险。
方法
本研究纳入了 58780 例宫颈癌患者，其中 54827 例为白种人，3953 例为亚裔美国人，所有患者的完整临床信息均可在美国监测、流行病学和最终结果数据库中获得。宫颈癌死亡被视为感兴趣的事件，其他原因的死亡被定义为竞争风险。应用累积发生率函数和 Fine-Gray 方法分别进行单因素和多因素分析。
结果
我们发现，对于所有患者（白种人和亚裔美国人合并），累积发生率函数与年龄、FIGO（国际妇产科联合会）分期、登记地区和淋巴结转移等因素有关。仅考虑白种人患者时，也得到了相似的结果。然而，对于亚裔美国人患者，登记地区与累积发生率函数无关，但其他因素（如 FIGO 分期）仍然具有统计学意义。同样，在多因素分析中，我们发现年龄、FIGO 分期、淋巴结转移、肿瘤组织学、治疗方法和种族均与预后相关。
结论
白种人和亚裔美国宫颈癌患者的生存状况不同。我们的结果可以指导对亚裔和白种美国宫颈癌患者的治疗，并有助于预后判断。
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