Ovarian Cancer Survival in African-American Women

摘要 虽然上皮性卵巢癌（EOC）是美国女性癌症死亡的第五大原因-与 非洲裔美国人（AA）妇女的生存率低于欧洲裔美国人（EA）妇女，但对这一点知之甚少。 影响AA生存的因素。造成这种差异的原因可能是多方面的，需要 从多个层面考察，包括影响邻里社会环境和个人的因素， 水平因素。我们认为，炎症暴露可能解释了EOC生存率的一些差异， AA女性由于炎症对癌变和预后的重要作用而具有较高的 炎症生物标志物存在于AA女性中。非裔美国人癌症流行病学研究 （AACES）是一项针对不同地理区域AA女性的多中心流行病学研究。由于 全面的数据收集，病理评估和随访时间，AACES是独特的定位 评估影响AA妇女EOC生存的因素。AACES招收了前所未有的 上一个资助期内AA参与者的数量，使AACES成为最大的卵巢癌研究 迄今为止，在AA女性中：595名患有侵袭性EOC的AA女性和752名对照。在AACES之前，无流行病学 卵巢癌的研究已经招募了超过150个AA病例和150个AA对照。的首要目标 这项建议是通过扩大招募来收集第一个AA EOC幸存者的队列研究， 样本量约为944例，对现有AACES病例进行持续随访。我们提出了一种新颖的多层次 方法来评估邻里，生活方式因素和生物标志物对生存的影响。我们建议 以下目标建立在我们目前的基础设施和成就：1）调查的影响， 邻里社会和物理环境对EOC生存的影响; 2）评估个体之间的关联 特征和EOC生存率; 3）表征可能是关键治疗的炎性肿瘤标志物 目标;和4）使用多层次建模来整合目标1-3变量的影响。我们的多- 学科研究团队在卵巢癌研究的各个方面都有丰富的经验， 确保全面的，协同的方法来了解影响AA妇女生存的因素 诊断为侵袭性EOC。流行病学和预后因素的信息严重不足， 卵巢癌的生存AA妇女是全面解决在拟议的研究。我们的研究将 为降低患有卵巢癌的AA妇女的死亡率提供信息策略。

ABSTRACT Although epithelial ovarian cancer (EOC) is the fifth-leading cause of cancer death in women in the U.S.—with worse survival in African-American (AA) women than European-American (EA) women—little is known about factors affecting survival among AAs. The causes for this disparity are likely multifactorial and need to be examined from multiple levels, including factors affecting the neighborhood social environment and individual- level factors. We posit that inflammatory exposures may explain some of the disparity in EOC survival among AA women due to important role of inflammation on carcinogenesis and prognosis and the higher levels of inflammatory biomarkers present among AA women. The African American Cancer Epidemiology Study (AACES) is a multi-site epidemiologic study of AA women in diverse geographic regions. Due to comprehensive data collection, pathology assessment and length of follow-up, AACES is uniquely positioned to evaluate factors influencing the survival of EOC in AA women. AACES has enrolled an unprecedented number of AA participants during a previous funding period, making AACES the largest study of ovarian cancer in AA women to date: 595 AA women with invasive EOC and 752 controls. Prior to AACES, no epidemiologic study of ovarian cancer had enrolled more than 150 AA cases and 150 AA controls. The overarching goal of this proposal is to assemble the first cohort study of AA EOC survivors by expanding recruitment to reach a sample size of ~944 cases and continuing follow-up of existing AACES cases. We propose a novel multi-level approach to evaluate the impact of neighborhood, lifestyle factors and biomarkers on survival. We propose the following aims that build on our current infrastructure and accomplishments: 1) investigate the effects of the neighborhood social and physical environment on EOC survival; 2) evaluate the association between individual characteristics and EOC survival; 3) characterize inflammatory tumor markers that may be key treatment targets; and 4) use multi-leveling modeling to integrate the impact of the Aim 1-3 variables. Our multi- disciplinary investigative team has extensive experience in all facets of ovarian cancer research, which ensures comprehensive, synergistic approaches to understanding factors that affect survival in AA women diagnosed with invasive EOC. The critical deficit of information on the epidemiologic and prognostic factors for ovarian cancer survival among AA women is addressed comprehensively in the proposed study. Our study will inform strategies to reduce mortality in AA women with EOC.