Saris Daniel H, Smith Anna Jo Bodurtha, Brensinger Colleen, Kim Sarah H, Haggerty Ashley F, Latif Nawar, Cory Lori, Giuntoli Robert L, Morgan Mark A, Lin Lilie L, Ko Emily M
Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, PA, USA.
Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, USA.
Gynecol Oncol Rep. 2022 Jan 6;40:100922. doi: 10.1016/j.gore.2022.100922. eCollection 2022 Apr.
To examine overall survival (OS) and cancer-specific survival (CSS) for different racial groups of women with surgically staged endometrial cancer by histologic subtype.
This is a retrospective cohort study of women with stage I-III endometrioid, serous, clear cell, and carcinosarcoma who underwent hysterectomy as primary surgical staging in the 2000-2016 SEER-Medicare database. OS and CSS outcomes were stratified by race (defined as White, Black, Other), stage, and histology. Survival was assessed with descriptive analyses, log-rank tests and unadjusted and adjusted multivariable cox regression models.
Of the 24,142 women identified, 85.5% were White, 8.5% Black, and 6% other races. Receipt of adjuvant therapy differed only for stage III endometrioid: Black women were less likely to receive adjuvant treatment after hysterectomy (61.2% vs. 70.1% White, p = 0.03). For stage I, Black women had worse CSS for all histologies other than clear cell in unadjusted and adjusted analyses. For stage II, Black women had worse CSS for endometrioid histology in unadjusted analyses and similar OS. For stage III, Black women with endometrioid carcinoma had worse CSS and OS in unadjusted analyses, but no significant difference in CSS in adjusted analyses. "Other" race showed improved OS for Stage I endometrioid adenocarcinoma without significant differences in outcomes when compared to White women.
Across histologies other than clear cell, Black women diagnosed with stage I endometrial cancer had consistently worse CSS, despite similar receipt of adjuvant therapy. Differences in CSS and OS at higher stages disappeared once accounting for treatment disparities.
按组织学亚型研究手术分期的子宫内膜癌不同种族女性的总生存期（OS）和癌症特异性生存期（CSS）。
这是一项对2000 - 2016年SEER - 医疗保险数据库中接受子宫切除术作为主要手术分期的I - III期子宫内膜样癌、浆液性癌、透明细胞癌和癌肉瘤女性进行的回顾性队列研究。OS和CSS结局按种族（定义为白人、黑人、其他）、分期和组织学进行分层。通过描述性分析、对数秩检验以及未调整和调整的多变量cox回归模型评估生存期。
在确定的24,142名女性中，85.5%为白人，8.5%为黑人，6%为其他种族。辅助治疗的接受情况仅在III期子宫内膜样癌中存在差异：黑人女性子宫切除术后接受辅助治疗的可能性较小（61.2%对白人的70.1%，p = 0.03）。对于I期，在未调整和调整分析中，除透明细胞癌外，黑人女性所有组织学类型的CSS均较差。对于II期，在未调整分析中，黑人女性子宫内膜样组织学的CSS较差，OS相似。对于III期，未调整分析中，患有子宫内膜样癌的黑人女性CSS和OS较差，但调整分析中CSS无显著差异。“其他”种族的I期子宫内膜样腺癌患者OS有所改善，与白人女性相比结局无显著差异。
除透明细胞癌外，在其他组织学类型中，被诊断为I期子宫内膜癌的黑人女性CSS始终较差，尽管辅助治疗的接受情况相似。一旦考虑到治疗差异，更高分期的CSS和OS差异就会消失。
