The Impact of Race and Comorbidity on Survival in Endometrial Cancer

Cancer Epidemiology Biomarkers and Prevention - Tập 21 Số 5 - Trang 753-760 - 2012
Sara H. Olson1,2, Coral L. Atoria1,2, Michele L. Coté1,2, Linda S. Cook1,2, Radhai Rastogi1,2, Robert A. Soslow1,2, Carol L. Brown1,2, Elena B. Elkin1,2
1Authors' Affiliations: 1Memorial Sloan-Kettering Cancer Center, New York; 2Karmanos Cancer Institute, Wayne State University School of Medicine, Wayne State University, Detroit, Michigan; and 3The University of New Mexico, Albuquerque, New Mexico
2The University of New Mexico, Albuquerque, New Mexico

Tóm tắt

AbstractBackground: Poorer survival from endometrial cancer in blacks than in whites is well documented. The aims of this study were to determine whether diabetes, hypertension, or other conditions influence survival and whether accounting for these conditions reduces this racial disparity.Methods: Using the SEER-Medicare database, we investigated the influence of diabetes, hypertension, and other comorbid conditions on survival in black and white women age ≥66 with endometrial cancer. We used Cox proportional hazards regression to evaluate the influence of comorbidities on survival for blacks and whites separately and to study survival differences between blacks and whites after adjustment for diabetes, hypertension, and other medical conditions, as well as for demographics, tumor characteristics, and treatment.Results: In both racial subgroups, women with diabetes or other conditions had poorer overall survival, whereas hypertensive black women experienced better survival [HR, 0.74; 95% confidence interval (CI), 0.60–0.92]. For disease-specific survival, diabetes was associated with poorer survival in white women (HR, 1.19; 95% CI, 1.06–1.35) but not in blacks (HR, 0.97; 95% CI, 0.73–1.30); hypertension and other conditions were not significantly related to survival. After adjustment, black women had poorer survival than white women, with HRs of 1.16 (95% CI, 1.05–1.28) for overall and 1.27 (95% CI, 1.08–1.49) for disease-specific survival.Conclusions: Diabetes influences disease-specific survival in white women but not in blacks. The racial disparity in survival is not explained by the presence of other health conditions.Impact: Further research should focus on the unknown factors that lead to poorer survival in black women compared with whites. Cancer Epidemiol Biomarkers Prev; 21(5); 753–60. ©2012 AACR.

Từ khóa


Tài liệu tham khảo

Siegel, 2012, Cancer statistics, 2012, CA Cancer J Clin, 62, 10, 10.3322/caac.20138

Fast Stats: An interactive tool for access to SEER cancer statistics. Surveillance Research Program, National Cancer Institute

Sherman, 2003, Analysis of racial differences in incidence, survival, and mortality for malignant tumors of the uterine corpus, Cancer, 98, 176, 10.1002/cncr.11484

Hill, 1996, Racial differences in endometrial cancer survival: the black/white cancer survival study, Obstet Gynecol, 88, 919, 10.1016/S0029-7844(96)00341-9

Hill, 1995, Racial differences in tumor grade among women with endometrial cancer, Gynecol Oncol, 56, 154, 10.1006/gyno.1995.1024

Farley, 2007, Racial disparities in blacks with gynecologic cancers, Cancer, 110, 234, 10.1002/cncr.22797

Allard, 2009, Race disparities between black and white women in the incidence, treatment, and prognosis of endometrial cancer, Cancer Control, 16, 53, 10.1177/107327480901600108

Maxwell, 2006, Racial disparity in survival among patients with advanced/recurrent endometrial adenocarcinoma: a Gynecologic Oncology Group study, Cancer, 107, 2197, 10.1002/cncr.22232

Santin, 2005, Racial differences in the overexpression of epidermal growth factor type II receptor (HER2/neu): a major prognostic indicator in uterine serous papillary cancer, Am Journal Obstet Gynecol, 192, 813, 10.1016/j.ajog.2004.10.605

Powell, 2002, Ribosomal DNA methylation in patients with endometrial carcinoma: an independent prognostic marker, Cancer, 94, 2941, 10.1002/cncr.10559

Maxwell, 2000, Racial disparity in the frequency of PTEN mutations, but not microsatellite instability, in advanced endometrial cancers, Clin Cancer Res, 6, 2999

Kohler, 1996, p53 overexpression in advanced-stage endometrial adenocarcinoma, Am J Obstet Gynecol, 175, 1246, 10.1016/S0002-9378(96)70036-4

Ostchega, 2007, Trends in hypertension prevalence, awareness, treatment, and control in older U.S. adults: data from the National Health and Nutrition Examination Survey 1988 to 2004, J Am Geriatr Soc, 55, 1056, 10.1111/j.1532-5415.2007.01215.x

Steiner, 2007, Diabetes mellitus is a multivariate independent prognostic factor in endometrial carcinoma: a clinicopathologic study on 313 patients, Eur J Gynaecol Oncol, 28, 95

Kauppila, 1982, Clinical outcome in endometrial cancer, Obstet Gynecol, 60, 473

Folsom, 2004, Diabetes as a risk factor for death following endometrial cancer, Gynecol Oncol, 94, 740, 10.1016/j.ygyno.2004.06.027

Chia, 2007, Obesity, diabetes, and other factors in relation to survival after endometrial cancer diagnosis, Int J Gynecol Cancer, 17, 441, 10.1111/j.1525-1438.2007.00790.x

Warren, 2002, Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population, Med Care, 40, IV-3, 10.1097/00005650-200208001-00002

Hebert, 1999, Identifying persons with diabetes using Medicare claims data, Am J Med Qual, 14, 270, 10.1177/106286069901400607

Charlson, 1987, A new method of classifying prognostic comorbidity in longitudinal studies: development and validation, J Chronic Dis, 40, 373, 10.1016/0021-9681(87)90171-8

Gray, 1988, A class of K-sample tests for comparing the cumulative incidence of a competing risk, Ann Stat, 16, 1141, 10.1214/aos/1176350951

Papanas, 2006, Endometrial carcinoma and diabetes revisited, Eur J Gynaecol Oncol, 27, 505

Linkov, 2008, Endometrial hyperplasia, endometrial cancer and prevention: gaps in existing research of modifiable risk factors, Eur J Cancer, 44, 1632, 10.1016/j.ejca.2008.05.001

Kaaks, 2002, Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review, Cancer Epidemiol Biomarkers Prev, 11, 1531

Kashima, 2009, Autocrine stimulation of IGF1 in estrogen-induced growth of endometrial carcinoma cells: involvement of the mitogen-activated protein kinase pathway followed by up-regulation of cyclin D1 and cyclin E, Endocr Relat Cancer, 16, 113, 10.1677/ERC-08-0117

Osei, 2010, Metabolic syndrome in blacks: are the criteria right?, Curr Diabetes Rep, 10, 199, 10.1007/s11892-010-0116-4

Kucirka, 2011, Association of race and age with survival among patients undergoing dialysis, JAMA, 306, 620

Cowie, 2006, Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health and Nutrition Examination Survey 1999–2002, Diabetes Care, 29, 1263, 10.2337/dc06-0062

Cutler, 2008, Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988–1994 and 1999–2004, Hypertension, 52, 818, 10.1161/HYPERTENSIONAHA.108.113357

Armstrong, 2011, Racial differences in surgeons and hospitals for endometrial cancer treatment, Med Care, 49, 207, 10.1097/MLR.0b013e3182019123

Onega, 2010, Race versus place of service in mortality among medicare beneficiaries with cancer, Cancer, 116, 2698, 10.1002/cncr.25097

Thông tin
Thông tin xuất bản

Cancer Epidemiology Biomarkers and Prevention

Tập 21 Số 5

753-760

Thông tin tác giả