Department of Genetic and Genome Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University Hospitals Cleveland and Case Western Reserve University, Cleveland, OH 44106, USA.
Int J Environ Res Public Health. 2022 Jul 15;19(14):8613. doi: 10.3390/ijerph19148613.
The number of Endometrial Carcinoma (EC) diagnoses is projected to increase substantially in coming decades. Although most ECs have a favorable prognosis, the aggressive, non-endometrioid subtypes are disproportionately concentrated in Black women and spread rapidly, making treatment difficult and resulting in poor outcomes. Therefore, this study offers an exploratory spatial epidemiological investigation of EC patients within a U.S.-based health system's institutional cancer registry ( = 1748) to search for and study geographic patterns. Clinical, demographic, and geographic characteristics were compared by histotype using chi-square tests for categorical and t-tests for continuous variables. Multivariable logistic regression evaluated the impact of risks on these histotypes. Cox proportional hazard models measured risks in overall and cancer-specific death. Cluster detection indicated that patients with the EC non-endometrioid histotypes exhibit geographic clustering in their home address, such that congregate buildings can be identified for targeted outreach. Furthermore, living in a high social vulnerability area was independently associated with non-endometrioid histotypes, as continuous and categorical variables. This study provides a methodological framework for early, geographically targeted intervention; social vulnerability associations require further investigation. We have begun to fill the knowledge gap of geography in gynecologic cancers, and geographic clustering of aggressive tumors may enable targeted intervention to improve prognoses.
子宫内膜癌(EC)的诊断数量预计在未来几十年将大幅增加。尽管大多数 EC 预后良好,但侵袭性、非子宫内膜样亚型不成比例地集中在黑人女性中,并迅速扩散,使治疗变得困难,导致预后不良。因此,本研究对美国医疗系统机构癌症登记处(=1748)的 EC 患者进行了探索性空间流行病学调查,以寻找和研究地理模式。使用卡方检验比较了分类变量的临床、人口统计学和地理特征,使用 t 检验比较了连续变量。多变量逻辑回归评估了风险对这些组织类型的影响。Cox 比例风险模型衡量了总体和癌症特异性死亡的风险。聚类检测表明,EC 非子宫内膜样组织类型的患者在其家庭住址上存在地理聚集,因此可以确定聚集建筑以进行有针对性的外展。此外,无论作为连续变量还是分类变量,居住在高社会脆弱性地区与非子宫内膜样组织类型独立相关。本研究为早期、有针对性的地理干预提供了方法框架;社会脆弱性关联需要进一步调查。我们已经开始填补妇科癌症中地理知识的空白,侵袭性肿瘤的地理聚集可能能够进行有针对性的干预,以改善预后。