Huang Yongmei, Hou June Y, Melamed Alexander, St Clair Caryn M, Khoury-Collado Fady, Gockley Allison, Ananth Cande V, Neugut Alfred I, Hershman Dawn L, Wright Jason D
Columbia University College of Physicians and Surgeons, New York, NY, USA; Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA.
Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA.
Gynecol Oncol. 2022 Apr;165(1):160-168. doi: 10.1016/j.ygyno.2022.02.004. Epub 2022 Feb 16.
To compare the patterns of care and outcomes of Asian-Americans/Pacific Islanders (AAPI) to non-Hispanic White (NHW) women with uterine cancer, and examine differences across Asian country of origin.
National Cancer Database was used to identify AAPI and NHW women with uterine cancer diagnosed from 2004 to 2017. Marginal multivariable log-linear regression models and Cox proportional-hazards models were developed to estimate differences in quality-of-care and all-cause mortality between AAPI and NHW women and across AAPI ethnic groups.
We identified 13,454 AAPI and 354,693 NHW women. Compared to NHW women, AAPI patients were younger at diagnosis (median age 57 vs. 62 years), had fewer comorbidities, more often had serous or sarcoma histologic subtypes and stage III/IV cancer. AAPI women had a slightly higher rate of receiving pelvic lymphadenectomy for deeply invasive or high-grade tumors (77.6% vs. 74.3%), and a lower rate of undergoing minimally invasive surgery (70.4% vs. 74.8%) for stage I-IIIC tumors. Among patients undergoing hysterectomy, AAPI women had a lower mortality compared with NHW women for cancer stage I/II/III, and a 28% reduction for type I (grade 1 or 2 endometrioid cancers) disease (aHR = 0.72; 95% CI, 0.64-0.81). Among AAPI subgroups, Pacific Islanders had the worst survival across different cancer stage and disease type.
AAPI women are diagnosed with uterine cancer at a younger age and have more aggressive histologic subtypes and advanced stage than their White counterparts. They have a similar level of quality-of-care as NHW women, and an improved survival for early stage and type I disease.
比较亚裔美国人/太平洋岛民（AAPI）与非西班牙裔白人（NHW）子宫癌女性的护理模式和结局，并研究不同亚洲原籍国之间的差异。
利用国家癌症数据库识别出2004年至2017年期间被诊断为子宫癌的AAPI和NHW女性。建立边际多变量对数线性回归模型和Cox比例风险模型，以估计AAPI和NHW女性之间以及不同AAPI种族群体之间在护理质量和全因死亡率方面的差异。
我们识别出13454名AAPI女性和354693名NHW女性。与NHW女性相比，AAPI患者诊断时年龄更小（中位年龄57岁对62岁），合并症更少，浆液性或肉瘤组织学亚型以及III/IV期癌症更为常见。对于深度浸润性或高级别肿瘤，AAPI女性接受盆腔淋巴结清扫术的比例略高（77.6%对74.3%），而对于I-IIIC期肿瘤，接受微创手术的比例较低（70.4%对74.8%）。在接受子宫切除术的患者中，对于癌症I/II/III期，AAPI女性的死亡率低于NHW女性，对于I型（1级或2级子宫内膜样癌）疾病，死亡率降低28%（风险比=0.72；95%置信区间，0.64-0.81）。在AAPI亚组中，太平洋岛民在不同癌症阶段和疾病类型中的生存率最差。
AAPI女性被诊断为子宫癌时年龄更小，组织学亚型比白人女性更具侵袭性，且分期更晚。她们的护理质量水平与NHW女性相似，早期和I型疾病的生存率有所提高。
