Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA
Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Int J Gynecol Cancer. 2020 Dec;30(12):1893-1901. doi: 10.1136/ijgc-2020-001560. Epub 2020 Aug 25.
African American women are increasingly being diagnosed with advanced and type II histology endometrial cancers. Outcomes have been observed to be worse in African American women, but whether or not race itself is a factor is unclear. We sought to evaluate the rates of diagnosis and outcomes on a stage-by-stage basis with respect to race using a large national cancer registry database.
The National Cancer Data Base was searched for patients with surgically staged non-metastatic endometrial cancer between 2004 and 2015. Women were excluded if surgical stage/histology was unknown, there was no follow-up, or no information on subsequent treatment. Pairwise comparison was used to determine temporal trends and Cox hazards tests with Bonferroni correction were used to determine overall survival.
A total of 286 920 women were diagnosed with endometrial cancer and met the criteria for analysis. Median follow-up was 51 months (IQR 25.7-85.3). In multivariable models, in women with stage I disease, African American women had a higher risk of death than Caucasian women (HR 1.262, 95% CI 1.191 to 1.338, p<0.001) and Asian/Pacific Islander women had a lower risk of death than Caucasian women (HR 0.742, 95% CI 0.689 to 0.801, p<0.001). This held for African American women with stage II type I and type II disease (HR 1.26, 95% CI 1.109 to 1.444, p<0.001 and HR 1.235, 95% CI 1.098 to 1.388, p<0.001) but not for Asian/Pacific Islander women. African American women with stage IIIA-B disease also had a higher risk of death for type I and type II disease versus Caucasian women (HR 1.221, 95% CI 1.045 to 1.422, p=0.010 and HR 1.295, 95% CI 1.155 to 1.452, p<0.001). Asian/Pacific Islander women had a lower risk of death than Caucasian women with type I disease (HR 0.783, 95% CI 0.638 to 0.960, p=0.019) and type II disease (HR 0.790, 95% CI 0.624 to 0.999, p=0.05). African American women with stage IIIC1-2 had a higher risk of death with type I disease (HR 1.343, 95% CI 1.207 to 1.494, p<0.001) and type II disease (HR 1.141, 95% CI 1.055 to 1.233, p=0.001) whereas there was no significant difference between Caucasian women and Asian/Pacific Islander women.
Race appears to play an independent role in survival from endometrial cancer in the USA, with African American women having worse survival on a stage-for-stage basis compared with Caucasian women.
越来越多的非裔美国女性被诊断出患有晚期和 II 型组织学子宫内膜癌。研究结果表明，非裔美国女性的预后较差，但种族是否是一个因素尚不清楚。我们旨在利用大型国家癌症登记数据库，根据种族在分期的基础上评估诊断率和预后。
在 2004 年至 2015 年期间，国家癌症数据库搜索了接受手术分期的非转移性子宫内膜癌患者。如果手术分期/组织学未知、没有随访或没有后续治疗信息，则排除这些患者。采用配对比较来确定时间趋势，采用 Bonferroni 校正的 Cox 风险测试来确定总生存率。
共有 286920 名女性被诊断为子宫内膜癌，并符合分析标准。中位随访时间为 51 个月（IQR 25.7-85.3）。在多变量模型中，在 I 期疾病的女性中，非裔美国女性的死亡风险高于白种女性（HR 1.262，95%CI 1.191 至 1.338，p<0.001），而亚裔/太平洋岛民女性的死亡风险低于白种女性（HR 0.742，95%CI 0.689 至 0.801，p<0.001）。对于 II 期 I 型和 II 型疾病的非裔美国女性，这种情况仍然存在（HR 1.26，95%CI 1.109 至 1.444，p<0.001 和 HR 1.235，95%CI 1.098 至 1.388，p<0.001），但对于亚裔/太平洋岛民女性则不然。对于 IIIA-B 期疾病的非裔美国女性，I 型和 II 型疾病的死亡风险也高于白种女性（HR 1.221，95%CI 1.045 至 1.422，p=0.010 和 HR 1.295，95%CI 1.155 至 1.452，p<0.001）。亚裔/太平洋岛民女性的 I 型疾病（HR 0.783，95%CI 0.638 至 0.960，p=0.019）和 II 型疾病（HR 0.790，95%CI 0.624 至 0.999，p=0.05）的死亡风险低于白种女性。对于 IIIC1-2 期疾病的非裔美国女性，I 型疾病（HR 1.343，95%CI 1.207 至 1.494，p<0.001）和 II 型疾病（HR 1.141，95%CI 1.055 至 1.233，p=0.001）的死亡风险较高，而白种女性和亚裔/太平洋岛民女性之间没有显著差异。
在美国，种族似乎在子宫内膜癌的生存中起着独立的作用，非裔美国女性与白种女性相比，在分期基础上的生存情况更差。
