患有卵巢癌的黑人女性的合并症与生存率

Comorbid conditions and survival among Black women with ovarian cancer.

作者信息

Richards Alicia R, Johnson Courtney E, Montalvo Nachalie Ramos, Alberg Anthony J, Bandera Elisa V, Bondy Melissa, Collin Lindsay J, Cote Michele L, Hastert Theresa A, Haller Kristin, Khanna Namita, Marks Jeffrey R, Peters Edward S, Qin Bo, Staples Jeanine, Terry Paul D, Lawson Andrew, Schildkraut Joellen M, Peres Lauren C

机构信息

Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA.

Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.

出版信息

Cancer. 2025 Jan 1;131(1):e35694. doi: 10.1002/cncr.35694.

DOI:10.1002/cncr.35694

PMID:39748467

Abstract

BACKGROUND

Black women with epithelial ovarian cancer (EOC) have worse survival and a higher burden of comorbid conditions compared with other racial groups. This study examines the association of comorbid conditions and medication use for these conditions with survival among Black women with EOC.

METHODS

In a prospective study of 592 Black women with EOC, the Charlson comorbidity index (CCI) based on self-reported data, three cardiometabolic comorbidities (type 2 diabetes, hypertension, and hyperlipidemia), and medication use for each cardiometabolic comorbidity were evaluated. Cox proportional hazards regression models were used to examine the association of comorbid conditions and related medication use with all-cause mortality while adjusting for relevant covariates overall and by histotype (high-grade serous [HGS]/carcinosarcoma vs. non-HGS/carcinosarcoma) and stage (I/II vs. III/IV).

RESULTS

A CCI of ≥2 was observed in 42% of the cohort, and 21%, 67%, and 34% of women had a history of type 2 diabetes, hypertension, and hyperlipidemia, respectively. After adjusting for prognostic factors, a CCI ≥2 (vs. 0; hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.04-1.71) and type 2 diabetes (HR, 1.42; 95% CI, 1.10-1.84) were associated with an increased risk of mortality. The increased risk of mortality for type 2 diabetes was present specifically among women with HGS/carcinosarcoma (HR, 1.47; 95% CI, 1.10-1.97) and among women with stage III/IV disease (HR, 1.47; 95% CI, 1.10-1.98). The authors did not find evidence that hypertension, hyperlipidemia, or medication use for the cardiometabolic comorbidities meaningfully impacted survival.

CONCLUSION

Comorbid conditions, especially type 2 diabetes, had a significant adverse impact on survival among Black women with EOC.

摘要

背景

与其他种族群体相比，患有上皮性卵巢癌（EOC）的黑人女性生存率更低，合并症负担更重。本研究探讨了这些合并症及其药物治疗与患有EOC的黑人女性生存率之间的关联。

方法

在一项对592名患有EOC的黑人女性的前瞻性研究中，基于自我报告数据评估了Charlson合并症指数（CCI）、三种心血管代谢合并症（2型糖尿病、高血压和高脂血症）以及每种心血管代谢合并症的药物使用情况。使用Cox比例风险回归模型来研究合并症及相关药物使用与全因死亡率之间的关联，同时对总体及按组织学类型（高级别浆液性[HGS]/癌肉瘤与非HGS/癌肉瘤）和分期（I/II期与III/IV期）调整相关协变量。

结果

42%的队列观察到CCI≥2，分别有21%、67%和34%的女性有2型糖尿病、高血压和高脂血症病史。在调整预后因素后，CCI≥2（与CCI为0相比；风险比[HR]，1.33；95%置信区间[CI]，1.04 - 1.71）和2型糖尿病（HR，1.42；95% CI，1.10 - 1.84）与死亡风险增加相关。2型糖尿病导致的死亡风险增加尤其在患有HGS/癌肉瘤的女性中（HR，1.47；95% CI，1.10 - 1.97）以及患有III/IV期疾病的女性中（HR，1.47；95% CI，1.10 - 1.98）。作者未发现证据表明高血压、高脂血症或针对心血管代谢合并症的药物使用对生存率有显著影响。