Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA.
Henry Ford Hospital, Department of Radiation Oncology, Detroit, MI, USA.
Gynecol Oncol. 2021 Jul;162(1):134-141. doi: 10.1016/j.ygyno.2021.04.036. Epub 2021 May 10.
To estimate overall survival, disease-specific survival, and progression-free survival among high grade endometrial carcinoma cases and to determine factors impacting survival for non-Hispanic white and non-Hispanic black women.
We identified high grade endometrial carcinoma cases among non-Hispanic white and non-Hispanic black women from ongoing institutional studies, and determined eligibility through medical record and pathologic review. We estimated effects of demographic and clinical variables on survival outcomes using Kaplan Meier methods and Cox proportional hazards modelling.
Non-Hispanic Black women with BMI <25.0 had poorest overall survival compared to non-Hispanic white women with BMI <25.0 (HR 3.03; 95% CI [1.35, 6.81]), followed by non-Hispanic black women with BMI 25.0+ (HR 2.43; 95% CI [1.28, 4.60]). A similar pattern emerged for disease-specific survival. Non-Hispanic black women also had poorer progression-free survival than non-Hispanic white women (HR 1.40; 95% CI [1.01, 1.93]). Other significant factors impacting survival outcomes included receipt of National Cancer Center Network (NCCN) guideline-concordant treatment (GCT), earlier stage at diagnosis, and fewer comorbid conditions.
BMI and race interact and modify the association with high grade endometrial carcinoma survival. Other potentially modifiable factors, such as reducing comorbidities and increasing access to GCT will potentially improve survival after diagnosis of high grade endometrial carcinomas. A better understanding of the molecular drivers of these high grade carcinomas may lead to targeted therapies that reduce morbidity and mortality associated with these aggressive tumors.
评估高级别子宫内膜癌病例的总生存率、疾病特异性生存率和无进展生存率，并确定影响非西班牙裔白人和非西班牙裔黑人群体生存的因素。
我们从正在进行的机构研究中确定了非西班牙裔白人和非西班牙裔黑人女性中的高级别子宫内膜癌病例，并通过病历和病理审查确定了入选标准。我们使用 Kaplan-Meier 方法和 Cox 比例风险模型来估计人口统计学和临床变量对生存结果的影响。
与 BMI<25.0 的非西班牙裔白人女性相比，BMI<25.0 的非西班牙裔黑人女性的总体生存率最差（HR 3.03；95%CI [1.35, 6.81]），其次是 BMI 为 25.0+的非西班牙裔黑人女性（HR 2.43；95%CI [1.28, 4.60]）。疾病特异性生存率也出现了类似的模式。非西班牙裔黑人女性的无进展生存率也比非西班牙裔白人女性差（HR 1.40；95%CI [1.01, 1.93]）。其他影响生存结果的重要因素包括接受国家癌症中心网络（NCCN）指南一致治疗（GCT）、诊断时更早的阶段和更少的合并症。
BMI 和种族相互作用并改变了与高级别子宫内膜癌生存的关联。其他潜在的可改变因素，如减少合并症和增加获得 GCT 的机会，可能会改善高级别子宫内膜癌诊断后的生存率。更好地了解这些高级别癌的分子驱动因素可能会导致靶向治疗，从而降低与这些侵袭性肿瘤相关的发病率和死亡率。
