Racial Disparities for Uterine Corpus Tumors Changes in Clinical Characteristics and Treatment Over Time
Racial Disparities for Uterine Corpus Tumors Changes in Clinical Characteristics and Treatment Over Time
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DOI：
10.1002/cncr.24160
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发表时间：
2009-03-15
期刊：
影响因子：
6.2
通讯作者：
Herzog, Thomas J.
中科院分区：
文献类型：
--
作者：
Wright, Jason D.;Fiorelli, Jessica;Herzog, Thomas J.
背景：患有子宫内膜癌的黑人女性比白人患者更有可能死亡。作者检查了与患有子宫体肿瘤的黑人妇女预后不良相关的因素，并分析了这些特征是否在诊断年份的基础上随着时间的推移而改变。方法：作者对1988年至2004年在监测、流行病学和结局数据库(SEER)中记录的子宫肿瘤患者进行了检查。作者建立了COX比例风险模型来检验种族对生存的影响，并按诊断年份将妇女分成3组：1988-1993年、1994-1998年、1999-2004年。结果：共鉴定出80915名患者，其中5564名(7%)为黑人女性。黑人患者明显更年轻，有更晚期的肿瘤，并且有更具侵袭性的非子宫内膜样组织学变异(P<；.001)。当与其他预后变量匹配时，黑人女性死于肿瘤的可能性比白人女性高60%(风险比，1.60；95%可信区间，1.51-1.69)。在这三个时间段中的每一个时间段，黑人的存活率都更差，即使是按分期和组织学分层。随着时间的推移，浆液性和透明细胞肿瘤的发生率增加，而放射治疗的使用在两个种族中都减少了。分期淋巴清扫术在最近接受治疗的黑人(45%)和白人(48%)中都更常见。结论：患有子宫体肿瘤的黑人女性更有可能死于该病。随着时间的推移，这种生存差异一直存在。黑人和白人的临床特征相对保持不变。接受手术分期的女性比例随着时间的推移而增加，并且在不同种族之间很好地匹配。癌症杂志2009；115：1276-85。(C)2009年美国癌症协会。
BACKGROUND: Black women with endometrial cancer have been more likely to die than white patients. The authors examined factors associated with the poor outcome for black women with uterine corpus tumors and analyzed whether these characteristics have changed over time based on year of diagnosis. METHODS: The authors examined women with uterine neoplasms recorded from 1988-2004 in the Surveillance, Epidemiology and End Results (SEER) Database. The authors developed Cox proportional hazards models to examine the effect of race on survival and stratified women by year of diagnosis into 3 groups: 1988-1993, 1994-1998, 1999-2004. RESULTS: A total of 80,915 patients including 5564 (7%) black women were identified. Black patients were significantly younger, had more advanced stage tumors, and had more aggressive, nonendometrioid histologic variants (P < .001). Black women were 60% more likely to die from their tumors than white women when matched for other prognostic variables (hazards ratio, 1.60; 95% confidence interval, 1.51-1.69). For each of the 3 time periods, survival was worse for blacks even when stratified by stage and histology. Over time, the incidence of serous and clear-cell tumors increased, and the use of radiation decreased for both races. Staging lymphadenectomy was performed more commonly in both blacks (45%) and whites (48%) who had been treated more recently. CONCLUSIONS: Black women with uterine corpus tumors were more likely to die from their disease. This survival difference has persisted over time. The clinical characteristics of blacks and whites have remained relatively constant. The proportion of women who undergo surgical staging has increased with time and was well matched between races. Cancer 2009;115:1276-85. (C) 2009 American Cancer Society.