Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN.
Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA.
Int J Cancer. 2020 May 1;146(9):2433-2441. doi: 10.1002/ijc.32569. Epub 2019 Jul 31.
Survival differences by racial and ethnic group have been reported in children and adolescents with germ cell tumors (GCTs), but whether these differences depend on stage of disease is unclear. Using the SEER 18 registries (2000-2015), we examined GCT survival differences by race/ethnicity (non-Hispanic white [NHW], Black, Asian/Pacific Islander [API], Hispanic) separately for males and females aged 0-19 years at diagnosis. We used Kaplan-Meier survival curves (Log-Rank p values) to characterize survival differences. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between race/ethnicity and death. Using an inverse odds weighting mediation analysis, we estimated the association between race/ethnicity and death treating stage of disease as the mediator. There were no significant racial/ethnic survival differences among females. Male survival differed by race/ethnicity (p < 0.0001) with NHW males having the best survival. Compared to NHW, API and Hispanic males had significantly higher risks of death (API HR: 2.18; 95% CI: 1.32-3.56; Hispanic HR: 1.98; 95% CI: 1.42-2.78) (model adjusted for age and year at diagnosis, tumor histology and location, stage). This association was mediated by stage of disease only among Hispanic males with gonadal tumors (indirect HR: 1.18; 95% CI: 1.03-1.35). The increased risk of death after a testicular GCT diagnosis observed among Hispanic males was mediated by stage of disease. For API males and Hispanic males with extragonadal tumors, other unidentified factors including differences in exposures, tumor biology or treatment received may impact the observed racial/ethnic survival disparities.
种族和民族群体之间的生存差异已在儿童和青少年生殖细胞瘤 (GCT) 中报道,但这些差异是否取决于疾病分期尚不清楚。使用 SEER 18 登记处 (2000-2015 年),我们分别检查了男性和女性 0-19 岁诊断时的种族/民族 (非西班牙裔白人 [NHW]、黑人、亚太裔 [API]、西班牙裔) 的 GCT 生存差异。我们使用 Kaplan-Meier 生存曲线 (对数秩检验 p 值) 描述生存差异。使用 Cox 比例风险模型估计种族/民族与死亡之间的关联的风险比 (HR) 和 95%置信区间 (95%CI)。使用逆概率加权中介分析,我们将疾病分期视为中介,估计种族/民族与死亡之间的关联。女性之间没有明显的种族/民族生存差异。男性的生存因种族/民族而异 (p<0.0001),NHW 男性的生存最好。与 NHW 相比,API 和西班牙裔男性的死亡风险显著更高 (API HR:2.18;95%CI:1.32-3.56;西班牙裔 HR:1.98;95%CI:1.42-2.78)(模型调整了年龄和诊断时的年份、肿瘤组织学和位置、分期)。这种关联仅在 Hispanic 男性的性腺肿瘤中通过疾病分期介导 (间接 HR:1.18;95%CI:1.03-1.35)。在 Hispanic 男性中,睾丸 GCT 诊断后死亡风险增加是由疾病分期介导的。对于 API 男性和 Hispanic 男性的性腺外肿瘤,其他未确定的因素,包括暴露、肿瘤生物学或接受的治疗差异,可能会影响观察到的种族/民族生存差异。