Zhou Shi-Hao, He Yong-Qiao, Diao Hua, Yang Da-Wei, Wang Tong-Min, Liao Ying, Jia Wei-Hua, Xue Wen-Qiong
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
Healthcare (Basel). 2025 Apr 22;13(9):964. doi: 10.3390/healthcare13090964.
This study aims to investigate the potential mediators for ethnic disparity in cervical cancer 5-year mortality and identify potential patients affected by ethnic disparities. The cohort study analyzed 56,374 cervical cancer patients from the Surveillance, Epidemiology, and End Results (SEER) 17 database (2000-2019). The primary and secondary outcome were the 5-year mortality of cervical cancer patients for all causes and cervical cancer-specific death, respectively. Cox and competing risks models were applied to identifying prognostic factors for 5-year cervical cancer all-cause mortality and specific death, respectively. Potential mediators for ethnic disparity were analyzed using multiple mediation analyses. NHB patients had a 49% higher risk of 5-year mortality than NHW patients, while Hispanic and API patients showed a 19% and 12% decreased risk, respectively. Mediation analyses revealed that clinical stage and surgery predominately contributed to NHW-NHB prognosis disparities, with an indirect effect proportion of 29.6% and 26.7% for all-cause mortality and 34.2% and 26.7% for disease-specific death, respectively. No significant mediation effect was observed for other ethnic disparities. Compared to NHW patients, the inferior prognosis of NHB patients was observed mainly for localized and regional cancer, receiving hysterectomy, and, especially, adenocarcinomas. Conversely, the superior prognosis of Hispanic and API patients was observed in the no surgery subgroup and mainly for squamous cell carcinomas. Delayed diagnosis and a lack of surgery are key contributors to the prognosis discrepancy between NHB and NHW patients. More attention should be paid to NHB patients with cervical adenocarcinoma to narrow the disparity.
本研究旨在调查宫颈癌5年死亡率种族差异的潜在中介因素，并确定受种族差异影响的潜在患者。队列研究分析了监测、流行病学和最终结果（SEER）17数据库（2000 - 2019年）中的56374例宫颈癌患者。主要和次要结局分别是所有原因导致的宫颈癌患者5年死亡率和宫颈癌特异性死亡。Cox模型和竞争风险模型分别用于确定宫颈癌5年全因死亡率和特异性死亡的预后因素。使用多重中介分析来分析种族差异的潜在中介因素。非裔美国患者5年死亡率风险比非西班牙裔白人患者高49%，而西班牙裔和亚裔太平洋岛民患者的风险分别降低了19%和12%。中介分析显示，临床分期和手术在很大程度上导致了非西班牙裔白人与非裔美国患者的预后差异，全因死亡率的间接效应比例分别为29.6%和26.7%，疾病特异性死亡的间接效应比例分别为34.2%和26.7%。未观察到其他种族差异有显著的中介效应。与非西班牙裔白人患者相比，非裔美国患者预后较差主要体现在局部和区域癌症、接受子宫切除术的患者中，尤其是腺癌患者。相反，西班牙裔和亚裔太平洋岛民患者在未进行手术的亚组中预后较好，且主要体现在鳞状细胞癌患者中。诊断延迟和缺乏手术是导致非裔美国患者与非西班牙裔白人患者预后差异的关键因素。应更加关注患有宫颈腺癌的非裔美国患者，以缩小差距。
