Do differences in medical comorbidities and treatment impact racial disparities in epithelial ovarian cancer?
Do differences in medical comorbidities and treatment impact racial disparities in epithelial ovarian cancer?
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DOI：
10.1016/j.ygyno.2017.10.035
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发表时间：
2018-04-01
影响因子：
4.7
通讯作者：
Leath, Charles A., III
中科院分区：
文献类型：
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作者：
Dilley, Sarah;Erickson, Britt K.;Leath, Charles A., III
背景基于人群的卵巢上皮癌女性研究表明，黑人女性的生存率低于白色女性。本研究的主要目的是确定在美国国家癌症研究所（NCI）指定的综合癌症中心（CCC）服务于不同种族和社会经济群体，种族是否与生存差异独立相关。我们对2004-2009年诊断为EOC的女性患者进行了回顾性分析，这些患者在我们的机构接受了治疗和随访。对人口统计学、合并症（根据Charlson合并症指数（CCI）定义）、肿瘤特征、治疗、无进展（PFS）和总生存期（OS）的记录进行了审查。使用Kaplan-Meier方法计算生存率，并与对数秩检验进行比较。多因素生存分析采用考克斯（比例风险）模型。367例患者符合入选标准。54例（15%）为黑人，308例（84%）为白色。与白色女性相比，黑人女性有较高的BMI，较低的最佳手术减瘤率，较低的腹腔化疗率和较高的CCI评分。黑人和白色女性的中位PFS分别为9.7和14.6个月（p = 0.033）。黑人妇女的中位总生存期为21.7个月，白色妇女为42.6个月（p < 0.001）。多因素分析显示，黑人与总生存率相关（HR 1.61，95%CI 1.06-2.43）。在该队列中，种族差异可能是由于较高的医学合并症和较低的最佳手术细胞减灭率。考虑到这些差异后，种族仍然是总生存率较差的独立预测因素。(C)2017爱思唯尔公司所有的灯都保留。
Background. Population-based studies of women with epithelial ovarian cancer suggest that black women have worse survival compared to white women. The primary objective of this study was to determine if, at a National Cancer Institute (NCI)-Designated Comprehensive Cancer Center (CCC) serving a diverse racial and socioeconomic population, race is independently associated with differences in survival.Methods. A retrospective review of women with EOC diagnosed between 2004-2009 undergoing treatment with follow-up at our institution was performed. Records were reviewed for demographics, comorbidities (as defined by the Charlson Comorbidity Index (CCI)), tumor characteristics, treatment, progression-free (PFS), and overall survival (OS). Survival was calculated using the Kaplan-Meier method and compared with the log-rank test. Multivariate survival analysis was performed with Cox (proportional hazards) model.Results. 367 patients met inclusion criteria. 54 (15%) were black and 308 (84%) were white. Compared to white women, black women had higher BMI, lower rates of optimal surgical cytoreduction, lower rates of intraperitoneal chemotherapy, and higher CCI scores. The median PFS for black and white women were 9.7 and 14.6 months, respectively (p = 0.033). The median overall survival was 21.7 months for black women and 42.6 months for white women (p < 0.001). On multivariate analysis, black race independently correlated with a worse overall survival (HR 1.61, 95% CI 1.06-2.43).Conclusion. In this cohort, racial disparities may be due to higher medical comorbidities and lower rates of optimal surgical cytoreduction. After accounting for these differences, race remained an independent predictor of worse overall survival. (C) 2017 Elsevier Inc. All lights reserved.