Black-White differences in uterine cancer symptomatology and stage at diagnosis.
Black-White differences in uterine cancer symptomatology and stage at diagnosis.
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子宫癌症状和诊断分期的黑白差异。
DOI：
10.1016/j.ygyno.2023.11.029
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发表时间：
2024
影响因子：
4.7
通讯作者：
Wright,JasonD
中科院分区：
文献类型：
--
作者：
Xu,Xiao;Chen,Ling;Nunez-Smith,Marcella;Clark,Mitchell;Ferris,JenniferS;Hershman,DawnL;Wright,JasonD
Objectives研究黑人和白色患者之间的子宫癌症状是否不同，以及这可能如何影响他们的诊断阶段。MethodsUsing the Surveillance，Epidemiology and End Results-Medicare database，我们在2008-2017年确定了2328名黑人和21,774名白色患者的子宫癌。她们在诊断前18个月内的症状被分类为单独的绝经后出血（PMB），PMB与其他症状（例如，腹部/骨盆疼痛，腹胀），非PMB症状单独，或没有症状。诊断时的分期被分为晚期（即，区域/远距离）与局部化。种族和阶段之间的关联进行了分析，逐步调整症状和其他患者characteristics.ResultsA更大比例的黑人比白色患者经历PMB与其他症状（63.1%对58.0%）或经历非PMB症状单独（13.1%对9.4%）（p< 0.001）。黑人患者的晚期诊断风险高于白色患者（45.0% vs 30.3%，未校正RR = 1.52，95% CI：1.44-1.59）。调整黑白症状差异后，RR降至1.46（95% CI：1.39-1.53）。与单纯PMB症状相比，有额外的非PMB症状（RR = 1.21，95%CI：1.15-1.26）和仅有非PMB症状（RR = 1.99，95%CI：1.88-2.10）与晚期诊断风险增加相关。进一步调整组织学和其他患者的特点减少黑-白差距在先进阶段的诊断为1.08（95%CI：1.03-1.14），但症状仍然显着相关的阶段在diagnosis.ConclusionsHaving非PMB症状与更先进的阶段在诊断。非PMB症状在黑人患者中比白色患者更常见，这可能会妨碍症状识别/评估。
ObjectiveTo examine whether uterine cancer symptoms differ between Black and White patients and how this may influence their stage at diagnosis.MethodsUsing the Surveillance, Epidemiology and End Results-Medicare database, we identified 2328 Black and 21,774 White patients with uterine cancer in 2008–2017. Their symptoms in the 18 months before diagnosis were categorized as postmenopausal bleeding (PMB) alone, PMB together with other symptoms (e.g., abdominal/pelvic pain, bloating), non-PMB symptoms alone, or no symptoms. Stage at diagnosis was dichotomized as advanced (i.e., regional/distant) versus localized. The association between race and stage was analyzed using regression models incrementally adjusting for symptoms and other patient characteristics.ResultsA larger proportion of Black than White patients experienced PMB together with other symptoms (63.1% versus 58.0%) or experienced non-PMB symptoms alone (13.1% versus 9.4%) (p< 0.001). Black patients had a higher risk of advanced-stage diagnosis than White patients (45.0% versus 30.3%, unadjusted RR = 1.52, 95% CI: 1.44–1.59). Adjusting for Black-White differences in symptoms attenuated the RR to 1.46 (95% CI: 1.39–1.53). Compared to PMB symptoms alone, having additional non-PMB symptoms (RR = 1.21, 95% CI: 1.15–1.26) and having non-PMB symptoms alone (RR = 1.99, 95% CI: 1.88–2.10) were associated with increased risk of advanced-stage diagnosis. Further adjusting for histology and other patient characteristics reduced Black-White disparity in advanced-stage diagnosis to 1.08 (95% CI: 1.03–1.14) but symptoms remained significantly associated with stage at diagnosis.ConclusionsHaving non-PMB symptoms was associated with more advanced stage at diagnosis. Non-PMB symptoms were more common among Black than White patients, which might hinder symptom recognition/evaluation.