Neoadjuvant Chemotherapy in Ovarian Cancer: Are There Racial Disparities in Use and Survival?
Neoadjuvant Chemotherapy in Ovarian Cancer: Are There Racial Disparities in Use and Survival?
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DOI：
10.1158/1055-9965.epi-22-0758
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发表时间：
2023-02-06
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影响因子：
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中科院分区：
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我们调查了治疗序列中的种族和民族差异（即，新辅助化疗（NACT）加间隔减瘤手术（IDS）与原发性减瘤手术（PDS）加辅助化疗）在卵巢癌患者中的作用及其对死亡率差异的影响。研究纳入了37，566名年龄≥18岁的女性，诊断为国家癌症数据库（2004-2017）中的III/IV期卵巢癌。使用逻辑回归计算治疗序列中种族和民族差异的比值比（OR）和95%置信区间（CI）。采用考克斯比例风险回归法估计全因死亡率中种族和民族差异的风险比（HR）和95%CI。与PDS+辅助化疗相比，非西班牙裔黑人（NHB）和亚洲女性接受NACT + IDS的可能性高于非西班牙裔白色（NHW）女性（OR：1.12，95% CI：1.02-1.22和OR：1.12，95% CI：0.99-1.28）。与NHW女性相比，NHB女性的死亡风险增加（HR：1.14，95% CI：1.09-1.20），而亚洲和西班牙裔女性的死亡风险较低（分别为HR：0.81，95% CI：0.74-0.88和HR：0.83，95% CI：0.77-0.88），在考虑治疗序列后未发生变化。NHB妇女更有可能接受NACT加IDS，并且比NHW妇女的死亡率更高。治疗顺序的差异不能解释卵巢癌死亡率的种族差异。需要进一步评估具有详细治疗信息的患者队列中治疗和生存的种族和民族差异。
We investigated racial and ethnic disparities in treatment sequence (i.e., neoadjuvant chemotherapy (NACT) plus interval debulking surgery (IDS) vs. primary debulking surgery (PDS) plus adjuvant chemotherapy) among ovarian cancer patients and its contribution to disparities in mortality. Study included 37,566 women aged ≥18 years, diagnosed with stage III/IV ovarian cancer from the National Cancer Database (2004–2017). Logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (CI) for racial and ethnic disparities in treatment sequence. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95%CI for racial and ethnic disparities in all-cause mortality. Non-Hispanic Black (NHB) and Asian women were more likely to receive NACT plus IDS relative to PDS plus adjuvant chemotherapy than non-Hispanic White (NHW) women (OR: 1.12, 95% CI: 1.02–1.22 and OR: 1.12, 95% CI: 0.99–1.28, respectively). Compared to NHW women, NHB women had increased hazard of mortality (HR: 1.14, 95% CI: 1.09–1.20), whereas Asian and Hispanic women had a lower hazard of mortality (HR: 0.81, 95% CI: 0.74–0.88 and HR: 0.83, 95% CI: 0.77–0.88, respectively), which did not change after accounting for treatment sequence. NHB women were more likely to receive NACT plus IDS and experience a higher mortality rates than NHW women. Differences in treatment sequence did not explain racial disparities in ovarian cancer mortality. Further evaluation of racial and ethnic differences in treatment and survival in a cohort of patients with detailed treatment information is warranted.
影响因子：
4.7
作者：
Barber EL;Dusetzina SB;Stitzenberg KB;Rossi EC;Gehrig PA;Boggess JF;Garrett JM
通讯作者：
Garrett JM