Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, NY, New York 10065, United States of America.
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, New York 10065, United States of America.
Gynecol Oncol. 2021 May;161(2):463-469. doi: 10.1016/j.ygyno.2021.01.041. Epub 2021 Feb 15.
Gaps in access to appropriate cancer care, and associated cancer mortality, have widened across socioeconomic groups. We examined whether demographic and socioeconomic factors influenced receipt of adjuvant radiation therapy (RT) in patients with high-risk, early-stage endometrial cancer.
A retrospective study cohort was selected from 349,404 endometrial carcinoma patients from the National Cancer Database in whom adjuvant RT would be recommended per national guidelines. The study included surgically treated patients with endometrioid endometrial cancer with one of the following criteria: 1) FIGO 2009 stage IB, grade 1/2 disease, age ≥ 60 years; 2) stage IB, grade 3 disease; or 3) stage II disease. Logistic regression analysis was performed to identify factors associated with omission of adjuvant RT. Association between adjuvant RT, covariables, and overall survival (OS) was assessed with multivariable Cox proportional hazards models.
19,594 patients were eligible for analysis; 47% did not receive adjuvant RT. Omission of adjuvant RT was more prevalent among African-American, Hispanic, and Asian compared to non-Hispanic white patients (OR 0.79, 95%CI: 0.69-0.91; OR 0.75, 95%CI: 0.64-0.87; OR 0.75, 95%CI: 0.60-0.94, respectively). Lower median household income of patient's area of residence, lack of health insurance, treatment at non-academic hospitals, farther distance to treatment facilities, and residence in metropolitan counties were associated with omission of adjuvant RT. Such omission was independently associated with worse OS (HR1.43, p < 0.001).
Adjuvant RT is omitted in 47% of patients with early-stage, high-risk endometrial cancer, which is associated with poor access to appropriate, high-quality care and worse outcome.
在不同社会经济群体中，获得适当癌症治疗的机会差距以及相关的癌症死亡率都在扩大。我们研究了人口统计学和社会经济因素是否会影响高危早期子宫内膜癌患者接受辅助放疗（RT）。
从国家癌症数据库中选择了 349404 名子宫内膜癌患者的回顾性研究队列，这些患者根据国家指南建议接受辅助 RT。研究包括接受手术治疗的子宫内膜样子宫内膜癌患者，符合以下标准之一：1）FIGO 2009 分期 IB，G1/2 级疾病，年龄≥60 岁；2）IB 期，G3 级疾病；或 3）II 期疾病。使用逻辑回归分析来确定与省略辅助 RT 相关的因素。使用多变量 Cox 比例风险模型评估辅助 RT、协变量与总生存期（OS）之间的关系。
19594 名患者符合分析条件；其中 47%的患者未接受辅助 RT。与非西班牙裔白人患者相比，非洲裔美国人、西班牙裔和亚洲患者省略辅助 RT 的情况更为普遍（OR 0.79，95%CI：0.69-0.91；OR 0.75，95%CI：0.64-0.87；OR 0.75，95%CI：0.60-0.94）。患者居住地的中等家庭收入中位数较低、缺乏医疗保险、在非学术医院接受治疗、到治疗设施的距离较远以及居住在大都市县都与省略辅助 RT 相关。这种省略与较差的 OS 独立相关（HR1.43，p<0.001）。
47%的高危早期子宫内膜癌患者省略了辅助 RT，这与获得适当高质量护理的机会较差以及结局较差有关。
