Racial Disparities, Survival & Secondary Debulking for Ovarian Cancer

描述（由申请人提供）：卵巢癌是女性癌症死亡的第四大原因。尽管努力改善检测，但仍有75%的妇女被诊断为晚期（III或IV期）疾病。晚期疾病的主要治疗包括原发性减体积手术，其中卵巢、子宫、输卵管和其他相关结构被切除，然后是化疗。即使有适当的初级治疗，第三和第四期的复发率也很高，从60%到95%不等。在卵巢癌的生存和接受适当的初级治疗方面存在种族差异。在卵巢癌的生存和初级手术治疗中存在种族差异。与白人妇女相比，非裔美国妇女更有可能在更年轻的时候被诊断出患有卵巢癌，疾病发展到晚期，不太可能接受初级手术治疗，即使接受手术治疗，也不太可能进行足够的淋巴结切除。自20世纪90年代初以来，二次减体积手术（切除大的肿瘤病变）越来越多地用于治疗复发性卵巢癌。目前的文献表明，这种方法可以提高生存率，但数据有限，因为它不是基于人群的，样本量很小，而且大多数研究都是在美国以外进行的。我们建议使用SEER-Medicare来获得卵巢癌复发率和各种复发癌症治疗率的估计。我们将比较第一次复发仅接受化疗的妇女与二次减积手术（有和没有化疗）的生存率。我们还将评估手术和生存方面的种族差异。我们的研究结果可以帮助告知复发性卵巢癌患者和医生的治疗决策，特别是少数民族妇女关于治疗复发性卵巢癌的决定。

DESCRIPTION (provided by applicant): Ovarian cancer is the 4th leading cause of cancer death in women. Despite efforts to improve detection, 75% of women are diagnosed with late stage (III or IV) disease. Primary treatment for late stage disease includes primary debulking surgery in which ovaries, uterus, fallopian tubes and other involved structures are removed, followed by chemotherapy. Even with adequate primary treatment, recurrence rates are high ranging from 60 to 95% for stages III and IV. Racial disparities in both survival from and in receipt of adequate primary treatment of ovarian cancer have been described. Racial disparities in ovarian cancer survival and primary surgical treatment abound. Compared to white women, African American women are more likely to be diagnosed with ovarian cancer at younger ages, with later stage disease, are less likely to undergo primary surgical treatment and among those who do have surgery, and are less likely to have adequate lymph node removal. Since the early 1990s, secondary debulking surgery, in which large tumor lesions are removed, is increasingly performed to treat recurrent ovarian cancer. Current literature suggests this procedure increases survival but data is limited in that it is not population-based, sample sizes are small and most studies are performed out of the US. We propose to use SEER-Medicare to obtain estimates of ovarian cancer recurrence and of various treatment rates for recurrent cancer. We will compare survival rates among women with first recurrence treated with chemotherapy only vs. secondary debulking surgery (with and without chemotherapy). We will also assess racial disparities in surgery and survival. Our findings can help inform both patients with recurrent ovarian cancer and physicians' treatment decision-making, particularly minority women's decisions about treatment for their recurrent ovarian cancer. PUBLIC HEALTH RELEVANCE: Secondary debulking surgery for ovarian cancer is increasingly being performed despite scant evidence of its effectiveness. Physicians and women with recurrent ovarian cancer need better evidence to inform their treatment decision-making. We aim to measure survival differences in women with recurrent ovarian cancer who undergo secondary debulking surgery versus those who do not using SEER-Medicare data.