Racial disparities in brachytherapy administration and survival in women with locally advanced cervical cancer
Racial disparities in brachytherapy administration and survival in women with locally advanced cervical cancer
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DOI：
10.1016/j.ygyno.2019.06.022
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发表时间：
2019-09-01
影响因子：
4.7
通讯作者：
King, Martin
中科院分区：
文献类型：
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作者：
Alimena, Stephanie;Yang, David D.;King, Martin
Objective.在美国，黑人妇女的宫颈癌发病率和死亡率最高。本研究使用国家癌症数据库评估了局部晚期宫颈癌接受近距离放射治疗（BT）的种族差异是否介导了种族间的生存差异。对2004年至2014年接受治疗的16，116名IB 2-IVA期宫颈癌女性进行了回顾性队列研究。未接受外照射放射治疗的妇女、生存数据或分期未知的妇女以及子宫切除术或盆腔清除术后的妇女被排除在外。进行多因素logistic回归分析，以评估与BT使用相关的因素。使用倾向评分调整模型和逆概率治疗加权，计算总生存期的调整风险比，包括BT和种族之间的相互作用项。在16,116名患者中，19.2%是黑人，55.8%接受了BT治疗。黑人女性接受BT的可能性明显较低（AOR 0.87，95%置信区间[CI] 0.79-0.96，p = 0.007），全因死亡率较低（中位生存期3.9年[95% CI 3.6-4.6] vs非黑人女性5.2年[95% CI 4.9-5.5]，p < 0.001）。在调整后的模型中，在未接受BT的女性中，与非黑人患者相比，黑人患者的死亡风险增加（AHR 1.14，95% CI 1.05-1.24; p = 0.002）。然而，当两组接受BT时，不同种族的生存率没有差异（AHR 1.04，95% CI 0.95-1.13，p = 0.42; p-相互作用= 0.005）。患有局部晚期宫颈癌的黑人女性不太可能接受近距离放射治疗，这会介导种族的生存差异。改善近距离放射治疗的可及性可能会提高总体生存率。(C)2019爱思唯尔公司All rights reserved.
Objective. Black women have the highest incidence and mortality from cervical cancer in the United States. This study evaluated whether racial disparities in the receipt of brachytherapy (BT) for locally advanced cervical cancer mediate survival differences by race using the National Cancer Database.Methods. A retrospective cohort study was performed using 16,116 women with stage IB2-IVA cervical cancer treated from 2004 to 2014. Women who did not receive external beam radiation therapy, those with unknown survival data or stage, and those status post hysterectomy or pelvic exenteration were excluded. Multivariate logistic regression was performed to evaluate factors associated with BT use. Using a propensity score adjusted model with inverse probability treatment weighting, adjusted hazard ratios for overall survival were calculated, including an interaction term between BT and race.Results. Of 16,116 patients, 19.2% were black and 55.8% received BT. Black women were significantly less likely to receive BT (AOR 0.87, 95% confidence interval [CI] 0.79-0.96, p = 0.007) and had worse all-cause mortality (median survival 3.9 years [95% CI 3.6-4.6] versus 5.2 years [95% CI 4.9-5.5] for non-black women, p < 0.001). In the adjusted model, black patients had an increased risk of death compared to non-black patients (AHR 1.14, 95% CI 1.05-1.24; p = 0.002) among women who did not receive BT. However, there was no difference in survival by race when both groups received BT (AHR 1.04, 95% CI 0.95-1.13, p = 0.42; p-interaction = 0.005).Conclusions. Black women with locally advanced cervical cancer are less likely to receive brachytherapy, which mediates survival differences by race. Improving access to brachytherapy may improve overall survival. (C) 2019 Elsevier Inc. All rights reserved.