Racial/Ethnic Disparities in Ovarian Cancer Treatment and Survival
Racial/Ethnic Disparities in Ovarian Cancer Treatment and Survival
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DOI：
10.1158/1078-0432.ccr-16-1119
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发表时间：
2016-12-01
影响因子：
11.5
通讯作者：
Kushi, Lawrence H.
中科院分区：
文献类型：
--
作者：
Bandera, Elisa V.;Lee, Valerie S.;Kushi, Lawrence H.
目的：在卵巢癌患者中，与其他种族/族裔群体相比，非裔美国 (AA) 女性的生存率较差。这是由于获得医疗保健的机会存在差异。实验设计：我们在北加州凯撒医疗机构的成员中进行了一项队列研究，评估了化疗剂量和生存率的种族/民族差异，从而获得同等的医疗保健机会。分析包括接受卡铂和紫杉醇一线辅助治疗的上皮浸润性卵巢癌病例 (n = 793)，中位随访时间为 50 个月。卡铂和紫杉醇的相对剂量强度 (RDI) 分别计算为每周给药剂量除以每周预期剂量，然后计算该方案的平均 RDI (ARDI)。调整相关协变量后，使用比例风险回归计算 HR 和 95% 置信区间 (CI)。结果：与白人相比，AA 更有可能出现剂量减少 (ARDI < 85%)、治疗延迟和提前停药的情况。西班牙裔也更有可能减少剂量，但提前停药或延迟治疗的可能性较小。在控制了 ARDI 等预后因素后，AA 女性的生存率最差。与白人相比，AA 的总死亡率调整后 HR (95% CI) 为 1.56 (1.01-2.39)；亚洲人为 0.89 (0.61-1.31)；西班牙裔为 1.41 (0.98-2.04)。卵巢癌特异性死亡率的结果相似。结论：在获得平等护理机会的女性中，卵巢癌治疗和 AA 生存率仍然存在差异。这些发现需要进一步评估可能导致这些差异的生物、个人和社会因素。 (C) 2016 年 AACR。
Purpose: Among patients with ovarian cancer, African American (AA) women experience poorer survival compared with other race/ethnicity groups. This has been attributed to differences in access to health care.Experimental Design: We evaluated racial/ethnic differences in chemotherapy dosing and survival in a cohort study among members of Kaiser Permanente Northern California, and thus with equivalent access to health care. Analyses included epithelial-invasive ovarian cancer cases (n = 793) receiving adjuvant first-line therapy of carboplatin and paclitaxel with curative intent, with median follow-up of 50 months. Relative dose intensity (RDI) was computed for carboplatin and paclitaxel separately as dose administered per week divided by expected dose per week, and average RDI (ARDI) was then calculated for the regimen. Proportional hazards regression was used to calculate HRs and 95% confidence intervals (CIs) after adjusting for relevant covariates.Results: Compared with whites, AAs were more likely to have dose reduction (ARDI < 85%), treatment delay, and early discontinuation. Hispanics were also more likely to have dose reduction, but less likely to have early discontinuation or treatment delay. After controlling for prognostic factors including ARDI, AA women had the worst survival. Compared with whites, adjusted HRs (95% CI) for overall mortality were 1.56 (1.01-2.39) for AAs; 0.89 (0.61-1.31) for Asians; and 1.41 (0.98-2.04) for Hispanics. Findings for ovarian cancer-specific mortality were similar.Conclusions: Disparities in ovarian cancer treatment and survival in AA persisted among women with equal access to care. These findings warrant further evaluation of biological, personal, and social factors that may be responsible for these differences. (C) 2016 AACR.