JNCI：种族和社会经济地位影响卵巢癌患者生存期

至今为止，在上皮性卵巢癌患者中，她们的种族和社会经济地位差异和其所接受的治疗质量及其生存期结局之间存在何种联系，目前还是未知数，为了试图找到上述要素间可能存在的关系，来自加利福尼亚大学妇产科系的Robert E. Bristow等进行了相关研究，并将其研究结果发表在JNCI 3月的在线期刊上。
本研究为基于人群的分析，受试者的资料来自于国家肿瘤资料数据库（NCDB）中侵袭性原发性上皮性卵巢癌患者的相应资料，上述患者在1998年至2002年间确诊，研究者将入组的患者分为白种人和黑人。并根据国家综合肿瘤网络（NCCN）所制定的指南根据患者的疾病分期为其制定合适的治疗方案——手术治疗或推荐化疗。本研究的主要结局为评估患者的种族和其社会经济地位对其对NCCN指南的依从性和其总体生存期的影响。研究者采用二项Logistic回归和多层次的生存分析对研究结果进行分析。
在研究中，共确定了47160名符合入组要求的患者，其中白种人为43995人，黑人为3165人。研究结果指出，不遵从NCCN指南推荐进行治疗是总体生存期差的独立预测因子，危险比为1.43,95%可信区间为1.38至1.47。并且研究者发现人口统计学特征与不接受NCCN指南推荐的治疗方案呈独立相关，黑人患者不接受NCCN指南推荐的治疗方案的比率更高，比值比为1.36,95%可信区间为1.25至1.48，此外Medicaid支付状态（Medicaid为由各级政府向穷人和残疾者提供的医疗保险方案）和非医保支付状态也影响到患者的治疗决策，比值比分别为1.20和1.33，95%可信区间分别为1.12至1.28和1.19至1.49。当研究者控制了与疾病和治疗相关的变量之后，能预测患者生存期的种族和社会经济预测因子为黑人（HR = 1.29, 95%可信区间为1.20至1.36）、Medicaid支付状态（HR = 1.29, 95%可信区间为1.20至1.38）、非医保支付状态（HR = 1.32, 95%可信区间为1.20至1.44），以及家庭平均收入低于$35 000 (HR = 1.06, 95%可信区间为1.02至1.11)。
来自本研究的结果指出对于不同的卵巢癌患者而言，她们所接受的治疗方案的质量和总体生存期存在显著差异，并且上述差异的存在除了与NCCN指南相关以外，还受到患者种族特征和社会经济状态的影响。根据本研究结果，我们必须继续努力以更准确的评估患者、医护提供者、医保体系和社会因素对上述差异的影响，从而更好的根据患者的具体情况进行临床决策的制定。
与卵巢癌相关的拓展阅读：

• JCO:阿巴伏单抗用于卵巢癌维持治疗无生存获益
• SGO：卵巢癌患者的最优治疗存在难题
• SGO：腹膜内灌注化疗可提高卵巢癌患者生存率
• SGO2013：心理素质高可改善卵巢癌预后
• Nature：卵巢癌干细胞微环境被揭示
• 高血钙水平或预示卵巢癌
更多信息请点击：有关卵巢癌更多资讯

Disparities in Ovarian Cancer Care Quality and Survival According to Race and Socioeconomic Status
Background
The relationship between racial and socioeconomic status (SES) disparities and the quality of epithelial ovarian cancer care and survival outcome are unclear.
Methods
A population-based analysis of National Cancer Data Base (NCDB) records for invasive primary epithelial ovarian cancer diagnosed in the period from 1998 to 2002 was done using data from patients classified as white or black. Adherence to National Comprehensive Cancer Network (NCCN) guideline care was defined by stage-appropriate surgical procedures and recommended chemotherapy. The main outcome measures were differences in adherence to NCCN guidelines and overall survival according to race and SES and were analyzed using binomial logistic regression and multilevel survival analysis.
Results
A total of 47 160 patients (white = 43 995; black = 3165) were identified. Non-NCCN-guideline-adherent care was an independent predictor of inferior overall survival (hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 1.38 to 1.47). Demographic characteristics independently associated with a higher likelihood of not receiving NCCN guideline-adherent care were black race (odds ratio [OR] = 1.36, 95% CI = 1.25 to 1.48), Medicare payer status (OR = 1.20, 95% CI = 1.12 to 1.28), and not insured payer status (OR = 1.33, 95% CI = 1.19 to 1.49). After controlling for disease and treatment-related variables, independent racial and SES predictors of survival were black race (HR = 1.29, 95% CI = 1.22 to 1.36), Medicaid payer status (HR = 1.29, 95% CI = 1.20 to 1.38), not insured payer status (HR = 1.32, 95% CI = 1.20 to 1.44), and median household income less than $35 000 (HR = 1.06, 95% CI = 1.02 to 1.11).
Conclusions
These data highlight statistically and clinically significant disparities in the quality of ovarian cancer care and overall survival, independent of NCCN guidelines, along racial and SES parameters. Increased efforts are needed to more precisely define the patient, provider, health-care system, and societal factors leading to these observed disparities and guide targeted interventions.