Ovarian Cancer Survival in African-American Women

摘要 尽管上皮性卵巢癌(EOC)是美国女性癌症死亡的第五大原因，但 非洲裔美国人(AA)女性的存活率比欧洲裔美国人(EA)女性更差--人们对此知之甚少 影响AAA存活率的因素。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。我们推测，炎症暴露可能解释了以下人群EOC存活率差异的部分原因 AA女性因炎症在肿瘤发生和预后中的重要作用而升高 炎性生物标志物存在于再生障碍性贫血妇女中。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的再生障碍性贫血妇女的多地点流行病学研究。由于 全面的数据收集、病理评估和随访时间长度，AACES具有独特的地位 目的探讨影响再障妇女卵巢上皮性癌存活率的因素。AACES招收了史无前例的 上一次资助期间AA参与者的数量，使AACES成为卵巢癌最大的研究 迄今为止，在再障女性中：595名患有侵袭性卵巢癌的再障女性和752名对照。在AACES之前，没有流行病学 卵巢癌研究共纳入150多例再生障碍性贫血病例和150例再生障碍性贫血对照。的首要目标是 这项建议是通过扩大招募范围来收集第一个对AA EOC幸存者的队列研究，以达到 样本量约为944例，并对现有AACES病例进行持续随访。我们提出了一种新颖的多层次 评估社区、生活方式因素和生物标记物对生存的影响的方法。我们建议 以下目标建立在我们现有基础设施和成就的基础上：1)调查 邻里社会物理环境对EoC生存的影响；2)评价个体之间的关联性 特征与EOC存活率；3)表征可能是关键治疗的炎性肿瘤标志物 4)采用多层次模型综合目标1-3个变量的影响。我们的多- 学科调查团队在卵巢癌研究的各个方面都有丰富的经验， 确保采用全面、协同的方法来了解影响再生障碍性贫血患者生存的因素 被诊断为侵袭性卵巢癌。关于流行性出血热流行病学和预后因素的信息严重不足 在这项拟议的研究中，AA妇女的卵巢癌生存率得到了全面的解决。我们的研究将 提供策略以降低患有EOC的再障妇女的死亡率。

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.