Morgan M A, Behbakht K, Benjamin I, Berlin M, King S A, Rubin S C
Department of Obstetrics and Gynecology, University of Pennsylvania Cancer Center, Philadelphia, USA.
Obstet Gynecol. 1996 Dec;88(6):914-8. doi: 10.1016/s0029-7844(96)00342-0.
To determine whether survival from gynecologic cancer is different between African-American and white patients at an inner-city hospital with both a large clinic and a private service.
We studied 538 patients (89 African American, 449 white) diagnosed with cervical, uterine, or ovarian cancer at a single institution from January 1, 1989 through December 31, 1993. Information was obtained on age, stage, site of disease, histology, and type of health insurance (public or commercial). Insurance coverage was used as a proxy for socioeconomic status. Overall survival was estimated by the method of Kaplan and Meier and compared by the log-rank test. Cox proportional hazard modeling was used to evaluate the effects of multiple factors on survival.
African-American patients were significantly older and were more likely to have cervical cancer and public insurance than white patients. Overall survival was worse for African-American patients than for white patients (P < .05). However, stage for stage, there was no significant difference in survival between the groups. There was also no difference when patients were grouped by insurance status. African Americans had a significantly worse survival for cervical cancer than whites, and African-American patients older than 65 years had a worse survival than whites of similar age. On multivariate analysis, only stage and insurance coverage were significant predictors of survival.
African-American patients with gynecologic cancer at our institution have worse overall survival than white patients. The survival difference seems to be due predominantly to differences in socioeconomic status and stage at diagnosis.
确定在一家拥有大型诊所和私人服务的市中心医院中，非裔美国患者与白人患者在妇科癌症生存率上是否存在差异。
我们研究了1989年1月1日至1993年12月31日期间在单一机构被诊断为宫颈癌、子宫癌或卵巢癌的538例患者（89例非裔美国人，449例白人）。获取了患者的年龄、分期、疾病部位、组织学以及医疗保险类型（公共或商业）等信息。保险覆盖情况被用作社会经济地位的替代指标。采用Kaplan-Meier法估计总生存率，并通过对数秩检验进行比较。使用Cox比例风险模型评估多种因素对生存率的影响。
非裔美国患者比白人患者年龄显著更大，患宫颈癌且拥有公共保险的可能性更高。非裔美国患者的总生存率低于白人患者（P <.05）。然而，在相同分期下，两组患者的生存率没有显著差异。按保险状况分组时也没有差异。非裔美国人宫颈癌患者的生存率显著低于白人，65岁以上的非裔美国患者生存率低于同龄白人。多因素分析显示，只有分期和保险覆盖情况是生存率的显著预测因素。
在我们机构中，患有妇科癌症的非裔美国患者的总生存率低于白人患者。生存差异似乎主要归因于社会经济地位和诊断时分期的差异。
