Pinheiro Paulo S, Medina Heidy N, Koru-Sengul Tulay, Qiao Baozhen, Schymura Maria, Kobetz Erin N, Schlumbrecht Matthew P
Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, United States.
Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, United States.
Front Oncol. 2021 Jul 20;11:699577. doi: 10.3389/fonc.2021.699577. eCollection 2021.
Endometrial cancer type 2 (EC2) carries a worse prognosis compared to EC type 1. EC2 disproportionately affects Black women among whom incidence is higher and survival is poorer compared to Whites. Here we assessed EC2 incidence and survival patterns among US Black ethnic groups: US-born Blacks (UBB), Caribbean-born Blacks (CBB), and Black Hispanics (BH).
We analyzed population-based data (n=24,387) for the entire states of Florida and New York (2005-2016). Hysterectomy-corrected EC2 incidence rates were computed by racial-ethnic group, and survival disparities were examined using Cox regression adjusting for tumor characteristics, poverty level, and insurance status.
EC2 incidence rates were highest among UBB (24.4 per 100,000), followed by CBB (18.2), Whites (11.1), and Hispanics of all races (10.1). Compared to Whites, the age-adjusted cause-specific survival was worse for non-Hispanic Blacks (aHR: 1.61; 95%CI 1.52-1.71) and Hispanics of all races (aHR:1.09; 95% CI:1.01-1.18). In relation to Whites, survival was worse for non-Hispanic Blacks: UBB (aHR:1.62; 95%CI 1.52-1.74) and CBB (aHR:1.59; 95% CI:1.44-1.76) than for BH (aHR:1.30; 95% CI:1.05-1.61). Surgical resection was associated with a lower risk of death, while carcinosarcoma subtype and advanced stage at diagnosis were associated with a greater risk.
Although higher EC2 incidence and lower survival are observed among all African-descent groups, there are significant intra-racial differences among UBB, CBB, and BH. This heterogeneity in EC2 patterns among Black populations suggests an interplay between genetic and socioenvironmental factors.
与1型子宫内膜癌（EC1）相比，2型子宫内膜癌（EC2）的预后更差。EC2对黑人女性的影响尤为严重，与白人相比，她们的发病率更高，生存率更低。在此，我们评估了美国黑人种族群体（美国出生的黑人[UBB]、加勒比出生的黑人[CBB]和西班牙裔黑人[BH]）中EC2的发病率和生存模式。
我们分析了佛罗里达州和纽约州（2005 - 2016年）基于人群的数据（n = 24,387）。通过种族 - 族裔群体计算经子宫切除术校正的EC2发病率，并使用Cox回归分析生存差异，同时调整肿瘤特征、贫困水平和保险状况。
EC2发病率在UBB中最高（每10万人中24.4例），其次是CBB（18.2例）、白人（11.1例）和所有种族的西班牙裔（10.1例）。与白人相比，非西班牙裔黑人（校正风险比[aHR]：1.61；95%置信区间[CI] 1.52 - 1.71）和所有种族的西班牙裔（aHR：1.09；95% CI：1.01 - 1.18）的年龄调整特定病因生存率更差。与白人相比，非西班牙裔黑人中，UBB（aHR：1.62；95% CI 1.52 - 1.74）和CBB（aHR：1.59；95% CI：1.44 - 1.76）的生存率比BH（aHR：1.30；95% CI：1.05 - 1.61）更差。手术切除与较低的死亡风险相关，而癌肉瘤亚型和诊断时的晚期阶段与较高的风险相关。
尽管在所有非洲裔群体中均观察到较高的EC2发病率和较低的生存率，但UBB、CBB和BH之间存在显著的种族内差异。黑人人群中EC2模式的这种异质性表明遗传因素和社会环境因素之间存在相互作用。
