低级别浆液性卵巢癌患者的护理差异。

Disparities in care among patients with low-grade serous ovarian carcinoma.

机构信息

Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States.

University of Miami Ryan White Program, Miami, FL, United States.

出版信息

Gynecol Oncol. 2020 Apr;157(1):46-54. doi: 10.1016/j.ygyno.2019.12.041. Epub 2020 Jan 31.

DOI:10.1016/j.ygyno.2019.12.041

PMID:32008792

Abstract

OBJECTIVE

Low-grade serous carcinoma (LGSC) is a rare histotype of ovarian cancer with a unique disease course. Little data exist regarding the influence of sociodemographic factors on diagnosis and outcomes in this disease. Our objective was to evaluate the associations between these factors and the clinical characteristics, treatment approaches, and survival in LGSC.

METHODS

The National Cancer Database (NCDB) was queried for data between 2004 and 2015 on patients with LGSC. LGSC was inclusive of invasive, grade 1, serous carcinoma of the ovary, fallopian tube, or peritoneum. Patient demographics, insurance status, disease characteristics, treatment approach, and survival were evaluated. ANOVA, Chi Square, Kaplan-Meier, and Cox regression were used in the analysis.

RESULTS

3221 patients with LGSC were evaluated (89.5% White, 6.2% Black; 7.2% Hispanic, 92.8% non-Hispanic). Compared to Whites, Blacks were diagnosed younger (50.4 vs. 55.9 years, p < 0.01), received less chemotherapy (61.8% vs 67.0%, p = 0.04), and had less CA-125 elevation (OR 4.14 [1.26-13.57], p = 0.02). Compared to non-Hispanics, Hispanics were younger (49.5 vs. 55.8 years, p < 0.01) and received less chemotherapy (55% vs 67%, p < 0.001). In contrast to private insurance, government insurance was associated with a higher 30-day mortality (1.5% vs 0.01%, p < 0.001). Race/ethnicity were not predictive of OS, while older age (HR 1.013 [1.002-1.024], p = 0.03), advanced stage (HR 3.09 [2.15-4.43], p < 0.001), and government insurance (HR 2.33 [1.65-3.30], p < 0.001) were all independently associated with worse OS.

CONCLUSIONS

Significant differences exist in the clinical characteristics, treatments, and outcomes of LGSC by sociodemographics, with Blacks and Hispanics being diagnosed younger and receiving less chemotherapy. Age, stage, and insurance status were predictive of overall survival.

摘要

目的

低级别浆液性癌（LGSC）是一种罕见的卵巢癌组织学类型，具有独特的疾病进程。关于社会人口因素对该疾病诊断和结局的影响，数据很少。我们的目的是评估这些因素与 LGSC 的临床特征、治疗方法和生存之间的关系。

方法

从 2004 年至 2015 年，国家癌症数据库（NCDB）中检索 LGSC 患者的数据。LGSC 包括浸润性、1 级、卵巢、输卵管或腹膜的浆液性癌。评估患者的人口统计学、保险状况、疾病特征、治疗方法和生存情况。采用方差分析、卡方检验、Kaplan-Meier 分析和 Cox 回归进行分析。

结果

共评估了 3221 例 LGSC 患者（89.5%为白人，6.2%为黑人；7.2%为西班牙裔，92.8%为非西班牙裔）。与白人相比，黑人的诊断年龄较小（50.4 岁 vs. 55.9 岁，p < 0.01），接受的化疗较少（61.8% vs. 67.0%，p = 0.04），CA-125 升高较少（OR 4.14 [1.26-13.57]，p = 0.02）。与非西班牙裔相比，西班牙裔的诊断年龄较小（49.5 岁 vs. 55.8 岁，p < 0.01），接受的化疗也较少（55% vs. 67%，p < 0.001）。与私人保险相比，政府保险与 30 天死亡率较高相关（1.5% vs. 0.01%，p < 0.001）。种族/民族与 OS 无关，而年龄较大（HR 1.013 [1.002-1.024]，p = 0.03）、晚期疾病（HR 3.09 [2.15-4.43]，p < 0.001）和政府保险（HR 2.33 [1.65-3.30]，p < 0.001）均与较差的 OS 独立相关。