Differences in cervical cancer mortality among black and white women
Differences in cervical cancer mortality among black and white women
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DOI：
10.1016/s0029-7844(99)00334-8
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发表时间：
1999-10-01
影响因子：
7.2
通讯作者：
Concato, J
中科院分区：
文献类型：
--
作者：
Howell, EA;Chen, YT;Concato, J
目的：确定疾病分期和治疗模式是否解释了黑人和白人妇女宫颈癌死亡率的差异。方法：利用1988-1994年监测、流行病学和最终结果（SEER）项目的数据，我们确定了种族与分期、种族与治疗之间的关系。在长达7年的随访中，根据年龄、婚姻状况、SEER位置、国际妇产科学联合会（FIGO）疾病分期、淋巴结状况、分级、组织学和治疗调整了种族间的生存差异。结果：黑人妇女的累积死亡率为36%（1029名妇女中有366人死亡），白人妇女为24%（5021名妇女中有1215人死亡）；未调整风险比为1.60（95%可信区间[CI] 1.43, 1.80）。黑人妇女比白人妇女更有可能出现晚期疾病（43.8%比34.8%）。在调整了人口统计学和FIGO分期的模型中，与白人女性相比，黑人女性的风险比降至1.35 （95% CI 1.19, 1.54）。治疗因种族而异，与白人女性相比，黑人女性接受手术的频率较低（分别为33.5%和48.2%），而接受放射治疗的频率较高（分别为35.3%和25.2%）。在一个包括人口统计学因素、FIGO分期、其他肿瘤特征和治疗的综合模型中，黑人妇女死亡率的调整风险比仍然很高，为1.30 （95% CI 1.14, 1.48）。结论：在考虑了年龄、疾病分期、治疗模式和其他因素后，种族仍然是宫颈癌生存的独立预测因子。未来的研究应该评估疾病的临床严重程度、合并症和社会经济地位的种族差异。（中华妇产科杂志1999；94:509-15）(C) 1999年由美国妇产科医师学会出版。
Objective: To determine whether stage of disease and treatment patterns account for mortality differences between black and white women with cervical cancer.Methods: Using data obtained from the Surveillance, Epidemiology, and End Results (SEER) Program for 1988-1994, we determined the associations between race and stage, and race and treatment. Racial differences in survival for up to 7 years of follow-up were adjusted for age, marital status, SEER location, International Federation of Gynecology and Obstetrics (FIGO) stage of disease, lymph node status, grade, histology, and treatment.Results: Cumulative mortality was 36% (366 deaths in 1029 women) for black women and 24% (1215 deaths in 5021 women) for white women; unadjusted hazard ratio was 1.60 (95% confidence interval [CI] 1.43, 1.80). Black women were more likely to present with advanced disease than white women (43.8% compared with 34.8%). In a model adjusting for demographics and FIGO stage, the hazard ratio for black women compared with white women decreased to 1.35 (95% CI 1.19, 1.54). Treatment varied by race, with black women receiving surgery less often (33.5% compared with 48.2%, respectively) and radiation therapy more often (35.3% and 25.2%, respectively) than white women. In a comprehensive model including demographic factors, FIGO stage, other tumor characteristics, and treatment, the adjusted hazard ratio for mortality remained high for black women at 1.30 (95% CI 1.14, 1.48).Conclusion: Race remains an independent predictor of cervical cancer survival after accounting for age, stage of disease, treatment patterns, and other factors. Future studies should assess racial differences in clinical severity of disease, comorbidity, and socioeconomic status. (Obstet Gynecol 1999;94:509-15. (C) 1999 by The American College of Obstetricians and Gynecologists.).