种族差异在子宫和卵巢癌肉瘤中的表现：基于人群的治疗和生存分析。
Racial disparities in uterine and ovarian carcinosarcoma: A population-based analysis of treatment and survival.
机构信息
Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.
出版信息
Gynecol Oncol. 2020 Apr;157(1):67-77. doi: 10.1016/j.ygyno.2020.01.017. Epub 2020 Feb 4.
OBJECTIVE
To investigate racial disparities in uterine carcinosarcoma (UCS) and ovarian carcinosarcoma (OCS) in Commission on Cancer®-accredited facilities.
METHODS
Non-Hispanic Black (NHB) and non-Hispanic White (NHW) women in the National Cancer Database diagnosed with stage I-IV UCS or OCS between 2004 and 2014 were eligible. Differences by disease site or race were compared using Chi-square test and multivariate Cox analysis.
RESULTS
There were 2830 NHBs and 7366 NHWs with UCS, and 280 NHBs and 2586 NHWs with OCS. Diagnosis of UCS was more common in NHBs (11.5%) vs. NHWs (3.7%) and increased with age (P < .0001). OCS diagnosis remained <5% in both races and all ages. NHBs with UCS or OCS were more common in the South and more likely to have a comorbidity score ≥ 1, low neighborhood income and Medicaid or no insurance (P < .0001). Diagnosis at stage II-IV was more common in NHBs than NHWs with UCS but not OCS. NHBs with both UCS and OCS were less likely to undergo surgery and to achieve no gross residual disease with surgery (P = .002). Risk of death in NHB vs. NHW patients with UCS was 1.38 after adjustment for demographic factors and dropped after sequential adjustment for comorbidity score, neighborhood income, insurance status, stage and treatment by 4%, 16%, 7%, 19% and 10%, respectively, leaving 43.5% of the racial disparity in survival unexplained. In contrast, risk of death in NHBs vs. NHWs with OCS was 1.19 after adjustment for demographic factors and became insignificant after adjustment for comorbidity. Race was an independent prognostic factor in UCS but not in OCS.
CONCLUSIONS
Racial disparities exist in characteristics, treatment and survival in UCS and OCS with distinctions that merit additional research.
目的
调查美国癌症协会（Commission on Cancer®）认证机构中子宫癌肉瘤（UCS）和卵巢癌肉瘤（OCS）的种族差异。
方法
2004 年至 2014 年间，国家癌症数据库中诊断为 I-IV 期 UCS 或 OCS 的非西班牙裔黑人（NHB）和非西班牙裔白人（NHW）女性符合条件。使用卡方检验和多变量 Cox 分析比较疾病部位或种族的差异。
结果
UCS 患者中，NHB 为 2830 例，NHW 为 7366 例；OCS 患者中，NHB 为 280 例，NHW 为 2586 例。与 NHW（3.7%）相比，NHB 中 UCS 的诊断更为常见（11.5%），且随年龄增长而增加（P<.0001）。在两个种族和所有年龄段，OCS 的诊断均<5%。UCS 或 OCS 的 NHB 更常见于南部，且更有可能患有合并症评分≥1、社区收入低、医疗补助或无保险（P<.0001）。与 NHW 相比，NHB 中 UCS 的 II-IV 期诊断更为常见，但 OCS 则不然。与 NHW 相比，UCS 和 OCS 的 NHB 更不可能接受手术，且手术时无肉眼残留疾病的可能性更小（P=0.002）。在调整了人口统计学因素后，与 NHW 相比，UCS 的 NHB 患者的死亡风险为 1.38，在连续调整合并症评分、社区收入、保险状况、分期和治疗后，分别下降了 4%、16%、7%、19%和 10%，仍然有 43.5%的生存率差异无法解释。相比之下，在调整了人口统计学因素后，与 NHW 相比，OCS 的 NHB 患者的死亡风险为 1.19，调整合并症后变得无统计学意义。在 UCS 中，种族是一个独立的预后因素，但在 OCS 中则不是。
结论
UCS 和 OCS 在特征、治疗和生存方面存在种族差异，这些差异值得进一步研究。
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