Uterine cancer survival disparities, Hispanic ethnicity, and comorbidities.

描述（由申请人提供）：现在子宫癌妇女的总体相对生存率比1975年更差。曾经被认为是“可治愈的癌症”的子宫内膜癌，其5年生存率现在低于其他10种癌症，包括乳腺癌和前列腺癌。这种疾病的负担是巨大的；大约每12个美国女性中就有1个在她们的一生中被诊断出患有子宫内膜癌。此外，存在着显著的种族/民族差异。白人和黑人之间子宫癌生存率的差异已经被注意和研究，但对非西班牙裔白人（NHWs）和西班牙裔白人（HWs）之间的差异知之甚少。根据我们自己对监测、流行病学和最终结果项目（SEER）数据的初步检查，我们发现在新墨西哥州和加利福尼亚州，卫生保健工作者的观察生存率始终低于卫生保健工作者。虽然造成这种差异的原因尚不清楚，但健康护理人员和健康护理人员之间共病的差异是一种可能的解释，因为共病会降低癌症诊断后的生存率。由于高血压和糖尿病都是子宫内膜癌的既定危险因素，我们预计在癌症诊断中，健康护理人员中合并症的患病率高于健康护理人员，而健康护理人员中糖尿病和高血压等合并症的患病率高于健康护理人员。我们假设合并症，特别是糖尿病和高血压，可以部分或全部解释健康护理人员和健康护理人员之间的生存差异。我们建议在新墨西哥州和加利福尼亚的三个地区（洛杉矶、旧金山-奥克兰、圣何塞-蒙特雷）使用SEER-Medicare链接数据库来探索这个问题。我们将比较HW和NHW病例的肿瘤特征、患者特征和癌症治疗。我们还将确定对合并症的调整是否会减少或消除健康护理人员和健康护理人员之间的生存差异。如果我们发现HWs和NHWs之间的肿瘤特征（如组织学、分期）不同，这一发现将为未来探索这些差异的病因学基础以及进一步研究肿瘤受体表达和DNA谱奠定基础。如果我们发现一种或多种合并症至少部分解释了生存差异，这一发现将成为未来研究干预措施（治疗或生活方式）的基础，以专门降低子宫癌死亡率。到2050年，估计将有1.03亿美国人是拉丁裔/西班牙裔，占美国人口的24%。为了更好地了解子宫癌差异的原因而进行的研究投资将有助于我们制定策略，改善这一常见妇科癌症在我们人口中庞大且不断增长的部分的预后和生存率。

DESCRIPTION (provided by applicant): Overall relative survival for women with uterine cancer is worse now than in 1975. Once thought to be the "curable cancer", the five-year survival for endometrial cancer is now lower than 10 other types of cancer, including breast and prostate. And the burden of this disease is substantial; approximately 1 in 12 American women will be diagnosed with endometrial cancer in their lifetime. Furthermore, there are striking racial/ethnic disparities. Disparities in uterine cancer survival between whites and blacks have been noted and studied, but little is known about disparities between non-Hispanic whites (NHWs) and Hispanic whites (HWs). Based upon our own preliminary examination of Surveillance, Epidemiology and End Results program (SEER) data, we found that HWs experience consistently worse observed survival than NHWs in New Mexico and California. While the reasons for this disparity are unknown, differences in comorbidities between HWs and NHWs is one possible explanation because comorbidities reduce survival following cancer diagnoses. We expect to see a higher prevalence of comorbidities in HWs relative to NHWs at cancer diagnosis because both hypertension and diabetes are established risk factors for endometrial cancer and there is a higher prevalence of comorbidities such as diabetes and hypertension in HWs relative to NHWs. We hypothesize that comorbidities, in particular diabetes and hypertension, may explain part or all of the survival disparities between HWs and NHWs. We propose to explore this question using the SEER-Medicare linked database in New Mexico and three areas in California (Los Angeles, San Francisco-Oakland, San Jose-Monterey). We will compare tumor characteristics, patient characteristcs, and cancer therapy between HW and NHW cases. We will also determine if adjustment for comorbidites reduces or eliminates the difference in survival between HWs and NHWs. If we find that tumor characteristics (e.g., histology, stage) are different between HWs and NHWs, this finding will be the basis for a future line of research exploring the etiologic basis for these differences as well as a further investigation of tumor receptor expression and DNA profiling. If we find that one or more comorbidities explain, at least in part, the survival disparity, this finding will be the basis for a future line of research to investigate interventions (therapeutic or lifestyle) to specifically reduce uterine cancer mortality. By 2050 it is estimated that 103 million Americans will be of Latino/Hispanic ethnicity, representing 24% of the United States (US) population. A research investment to better understand the reasons for uterine cancer disparities will help us develop strategies for improving prognosis and survival for this common gynecologic cancer in this large and growing segment of our population. PUBLIC HEALTH RELEVANCE: Project Narrative This project is directly aimed at understanding the factors that affect differential uterine cancer survival between Hispanic white women and non-Hispanic white women. The results of our study will provide needed clarity about factors that drive this disparity so that further research can be done to establish ways to reduce the survival disparity. In this manner, the results could have a direct impact on improving the long-term health of uterine cancer patients across the nation.