Obstetrics and Gynecology, University of Colorado at Denver - Anschutz Medical Campus, Aurora, Colorado, USA
Obstetrics and Gynecology, University of Colorado at Denver - Anschutz Medical Campus, Aurora, Colorado, USA.
Int J Gynecol Cancer. 2020 Jul;30(7):1018-1025. doi: 10.1136/ijgc-2019-000555. Epub 2020 Feb 26.
There has been an increase in the use of neoadjuvant chemotherapy in recent years. Our objective was to determine if African American women are more likely to receive neoadjuvant chemotherapy than primary debulking surgery, when compared to their Caucasian counterparts, and the impact of such an approach on oncologic outcomes.
A retrospective cohort study was performed using the National Cancer Database (NCDB). Women aged 18-90 years, diagnosed with stage IIIC or IV epithelial ovarian cancer between January 2010 through December 2014 were included. Women with unknown treatment or treatments outside of neoadjuvant chemotherapy or primary debulking surgery were excluded. Only women of Caucasian, African American, or Hispanic origin who received either neoadjuvant chemotherapy or primary debulking surgery were included; all other races were excluded. Descriptive statistics were computed, and continuous variables were assessed for normality. Groups were compared using ANOVA or non-parametric medians tests for continuous variables, and chi-squared tests were used for dichotomous or categorical variables. Logistic regression was used to identify predictors of treatment. A p value of 0.05 was considered statistically significant.
A total of 19 838 women with stage IIIC and IV epithelial ovarian cancer met the inclusion criteria. A total of 14 988 (75.6%) were treated with primary debulking surgery, while 4850 women (24.4%) were treated with neoadjuvant chemotherapy. Of those treated with neoadjuvant chemotherapy, 24.5% were white, 27.0% were African American, and 22.1% were Hispanic (p=0.005), and when adjusted for confounders, being African American was a predictor of receiving neoadjuvant chemotherapy (adjusted odds ratio (aOR) 1.29, 95% CI 1.10 to 1.51). Ninety-day mortality rates were higher in African American women compared with Caucasian and Hispanic women (2.9% vs 2.0% vs 1.6%, p=0.013). There were no differences in 30-day mortality, 90-day mortality, or status at last contact in African American women, when comparing neoadjuvant chemotherapy and primary debulking surgery. In Caucasian women, outcomes were worse in women receiving neoadjuvant chemotherapy.
Compared to other races, African American women with advanced ovarian cancer are more likely to receive neoadjuvant chemotherapy than primary debulking surgery and had a higher 90-day mortality rate. In African American women there was no difference in outcomes based on treatment type.
近年来，新辅助化疗的应用有所增加。我们的目的是确定与白人女性相比，非裔美国女性在接受新辅助化疗方面是否比接受主要肿瘤减灭术更有可能，以及这种方法对肿瘤学结果的影响。
本研究采用国家癌症数据库（NCDB）进行回顾性队列研究。纳入 2010 年 1 月至 2014 年 12 月期间诊断为 IIIC 期或 IV 期上皮性卵巢癌的年龄在 18-90 岁之间的女性。排除接受新辅助化疗或主要肿瘤减灭术以外的治疗或治疗方法未知的女性。仅纳入接受新辅助化疗或主要肿瘤减灭术的白人、非裔美国人和西班牙裔女性；所有其他种族均被排除。计算描述性统计数据，并评估连续变量的正态性。使用 ANOVA 或非参数中位数检验比较连续变量，使用卡方检验比较二分类或分类变量。使用逻辑回归识别治疗的预测因素。p 值<0.05 被认为具有统计学意义。
共有 19838 名 IIIC 和 IV 期上皮性卵巢癌女性符合纳入标准。共有 14988 名（75.6%）接受了主要肿瘤减灭术治疗，而 4850 名（24.4%）接受了新辅助化疗。在接受新辅助化疗的患者中，24.5%为白人，27.0%为非裔美国人，22.1%为西班牙裔（p=0.005），并且在调整混杂因素后，非裔美国人是接受新辅助化疗的预测因素（调整后的优势比（aOR）为 1.29，95%CI 为 1.10 至 1.51）。非裔美国女性的 90 天死亡率高于白人女性和西班牙裔女性（2.9%比 2.0%比 1.6%，p=0.013）。在非裔美国女性中，比较新辅助化疗和主要肿瘤减灭术时，30 天死亡率、90 天死亡率或最后一次联系时的状态无差异。在白人女性中，接受新辅助化疗的女性结局更差。
与其他种族相比，患有晚期卵巢癌的非裔美国女性更有可能接受新辅助化疗而不是主要肿瘤减灭术，并且 90 天死亡率更高。在非裔美国女性中，基于治疗类型的结局没有差异。
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