Hill H A, Coates R J, Austin H, Correa P, Robboy S J, Chen V, Click L A, Barrett R J, Boyce J G, Kotz H L
Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia 30322, USA.
Gynecol Oncol. 1995 Feb;56(2):154-63. doi: 10.1006/gyno.1995.1024.
Black women with endometrial cancer have more advanced disease and less favorable tumor grade than do white women. This study evaluated whether racial differences in tumor grade could be explained by hormone-related factors and other putative determinants of grade. Subjects included 207 white and 81 black postmenopausal women diagnosed with primary cancer of the uterine corpus between 1985 and 1987. Blacks had poorer tumor grade than whites (odds ratio for FIGO grade 2 versus grade 1 is 1.8; odds ratio for grade 3 versus grade 1 is 2.8). Over 75% of the excess of poorly differentiated tumors versus well-differentiated tumors among blacks could be explained by racial differences in use of replacement estrogens, age at first pregnancy, history of oophorectomy, poverty, stage of disease, use of screening, and access to health care. The most prominent factor was estrogen therapy, which was associated with favorable tumor grade and was used much less frequently by blacks. Although not statistically significant, a moderate racial difference in tumor grade remained after control of the potential explanatory explanatory variables. This may reflect true biologic variation between blacks and whites and may explain, in part, the observation that blacks with endometrial cancer have a worse prognosis.
患有子宫内膜癌的黑人女性比白人女性的疾病分期更晚，肿瘤分级更差。本研究评估了肿瘤分级的种族差异是否可以由激素相关因素和其他假定的分级决定因素来解释。研究对象包括1985年至1987年间诊断为原发性子宫体癌的207名白人绝经后女性和81名黑人绝经后女性。黑人的肿瘤分级比白人差（国际妇产科联盟（FIGO）2级与1级相比的优势比为1.8；3级与1级相比的优势比为2.8）。黑人中低分化肿瘤与高分化肿瘤相比，超过75%的差异可以由以下种族差异来解释：替代雌激素的使用、首次怀孕年龄、卵巢切除术史、贫困、疾病分期、筛查的使用以及获得医疗保健的机会。最突出的因素是雌激素治疗，其与良好的肿瘤分级相关，而黑人使用频率较低。尽管在统计学上不显著，但在控制潜在解释变量后，肿瘤分级仍存在适度的种族差异。这可能反映了黑人和白人之间真正的生物学差异，并且可能部分解释了患有子宫内膜癌的黑人预后较差这一观察结果。
