The effect of time on racial differences in epithelial ovarian cancer (OVCA) diagnosis stage, overall and by histologic subtypes: a study of the National Cancer Database.
The effect of time on racial differences in epithelial ovarian cancer (OVCA) diagnosis stage, overall and by histologic subtypes: a study of the National Cancer Database.
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DOI：
10.1007/s10552-016-0806-6
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发表时间：
2016-10
期刊：
影响因子：
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通讯作者：
Joslin CE
中科院分区：
文献类型：
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作者：
Beckmeyer-Borowko AB;Peterson CE;Brewer KC;Otoo MA;Davis FG;Hoskins KF;Joslin CE
以前评估卵巢癌（OVCA）诊断阶段的种族和民族差异的研究未能提供亚型特异性结果，并提供10至20年前诊断病例的历史数据。本分析的目的是评估非西班牙裔黑人（NHB）和非西班牙裔白色（NHW）在晚期诊断方面的差异，包括：1）与侵袭性上皮OVCA晚期诊断相关的总体因素和组织学亚型因素2）随时间推移的潜在变化，以及3）1998年至2011年期间美国和波多黎各国家癌症登记研究的当前趋势模式。NHB和NHW OVCA病例来自国家癌症数据库（NCDB）。诊断阶段分别作为二分和四级类别变量进行分析;早期（I期和II期;局部）与晚期（III期和IV期;区域和远处）以及I期、II期、III期和IV期。诊断期为1998-2002年、2003-2007年、2008-2011年。使用卡方统计检验阶段的种族差异。采用多变量二项和广义有序logistic回归估计比值比（OR）和95%置信区间（95%CI）。种族和诊断期间之间的相互作用进行了评估。在1998年至2011年期间，11，562（7.8%）NHB和137，106（92.2%）NHW被诊断患有OVCA。在校正模型中，NHB比NHW更可能被诊断为晚期OVCA（ORadj=1.26; 95%CI 1.19-1.33）。种族和诊断期之间的相互作用是轻微显著的（p值=0.09），分期的种族差异随时间推移而降低（1998-2002年：ORadj= 1.36，95%CI= 1.23-1.49; 2003-2007年：ORadj= 1.27，95%CI= 1.15-1.39; 2008-2011年：ORadj =1.15，95%CI= 1.05-1.27）。NHB也比NHW更可能被诊断为4期高级别浆液性（ORadj=1.46; 95%CI 1.22-1.74）、透明细胞（ORadj=2.71; 95%CI 1.94 - 3.79）和粘液性（ORadj=2.78; 95%CI 2.24 - 3.46）癌。晚期OVCA诊断存在种族差异;然而，这些差异随着时间的推移而减少。在NCDB中，NHB比NHW更有可能被诊断为晚期OVCA，更具体地说是高级别浆液性癌、透明细胞癌和粘液癌。
Previous studies assessing racial and ethnic differences in ovarian cancer (OVCA) diagnosis stage fail to present subtype-specific results and provide historic data on cases diagnosed between ten and twenty years ago. The purpose of this analysis is to assess non-Hispanic Black (NHB) and non-Hispanic White (NHW) differences in late stage diagnosis including; 1) factors associated with late-stage diagnosis of invasive epithelial OVCA overall and by histologic subtypes 2) potential changes across time, and, 3) current patterns of trends in a national cancer registry in the US and Puerto Rico between 1998 and 2011. NHB and NHW OVCA cases were derived from the National Cancer Database (NCDB). Diagnosis stage was analyzed as a dichotomous and a four-level category variable, respectively; early (stages I and II; localized) versus late (stages III and IV; regional and distant) and stages I, II, III and IV. Diagnosis period was trichotomized (1998–2002, 2003–2007, 2008–2011). Racial differences in stage were tested using Chi-square statistics. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated using multivariable binomial and generalized ordered logistic regressions. Interactions between race and diagnosis period were evaluated. Between 1998 and 2011, 11,562 (7.8%) NHB and 137,106 (92.2%) NHW were diagnosed with OVCA. In adjusted models, NHB were significantly more likely diagnosed with late-stage OVCA than NHW (ORadj=1.26; 95%CI 1.19–1.33). Interaction between race and diagnosis period was marginally significant (pvalue=0.09), with racial differences in stage decreasing over time (1998–2002: ORadj= 1.36, 95%CI= 1.23–1.49; 2003–2007: ORadj= 1.27, 95%CI= 1.15–1.39; 2008–2011; ORadj =1.15, 95%CI= 1.05–1.27). NHB were also more likely to be diagnosed with stage 4 high grade serous (ORadj=1.46; 95%CI 1.22–1.74), clear cell (ORadj=2.71; 95%CI 1.94 – 3.79) and mucinous (ORadj=2.78; 95%CI 2.24 – 3.46) carcinomas than NHW. Racial differences in late-stage OVCA diagnosis exist; however, these differences are decreasing with time. Within NCDB, NHB are significantly more likely diagnosed with late-stage OVCA and more specifically high-grade serous, clear cell and mucinous carcinomas than NHW.