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【medical-news】子宫癌存活率的种族因素
African-American women with uterine cancer have worse survival rates than Caucasian women who received similar treatment even though they had similar prognostic factors, according to a new review of four clinical trials. Published in the November 1, 2006 issue of CANCER (http://www.interscience.wiley.com/cancer-newsroom), a peer-reviewed journal of the American Cancer Society, the review found significant racial disparities in survival and clinical presentation of advanced/recurrent endometrial cancer. African-Americans presented with worse disease, but even after controlling for clinical features and treatment, African-Americans survived significantly fewer months than Caucasians, suggesting that other factors, such as socioeconomic, biologic, and cultural issues may have a strong influence on this disease outcome.
Ethnic and racial differences are observed in many cancers, such as breast and colon cancers. Population-based studies have also demonstrated clear racial disparities in the presentation, course and outcome of endometrial cancer. These studies clearly show that African-Americans present with more advanced disease and have lower survival rates than other racial groups. Analysis suggests that the cause is multifactorial and may be related to inequality of access to healthcare, cultural variations in response to disease, and differences in disease stage at presentation. Etiology, however, is difficult to discern due to methodological shortcomings in many studies, such as too few patients.
To further characterize the cause of outcome differences between African-Americans and Caucasians, G. Larry Maxwell, M.D. of the Department of Obstetrics and Gynecology at the Walter Reed Army Medical Center in Washington, DC and investigators analyzed demographic and clinical data from 1,151 patients who were enrolled in any of four randomized, control treatment trials with stage III, IV or recurrent endometrial cancer.
The authors identified racial disparities in outcome, even after controlling for presentation and treatment. African-Americans were at 26 percent greater risk of death from uterine cancer than Caucasians, even if they had similar diseases and treatments. "When response to treatment was analyzed, Blacks appeared to have lower tumor response to each of the chemotherapy regimens employed in the trials," the authors observe.
Analyzed by time, Africans-Americans survived a median 10.6 months compared to 12.2 months among Caucasians. At presentation, African-Americans were more likely than Caucasians to present with more serious disease, including papillary serous histology, stage IV disease, and higher tumor grade.
"While the causes of this survival difference remain to be elucidated, socioeconomic, biologic and cultural etiologies may be involved," conclude the authors. 我认领这篇 人种影响子宫癌的存活率
一项四个临床试验的综述显示，患有子宫癌的非洲裔美国妇女与高加索妇女相比有着更高的死亡率，虽然她们都接受相同的治疗并有着相似的影响预后的因素。这篇文章发表在CANCER杂志2006年11月1日的刊期上，该杂志是美国癌症协会的杂志。这篇文章发现晚期或复发的子宫内膜癌其存活率和临床表现在不同种族有着显著的差异。非洲裔的美国妇女临床表现更加糟糕，但即使在控制了临床的特征性表现并接受治疗后，非洲裔美国妇女存活率仍显著低于高加索妇女。这揭示可能存在其它因素，如社会经济的、生物的和文化方面的因素，对疾病的预后产生着强有力的影响。
许多癌都表现出人种和民族的差异，如乳腺癌和结肠癌。以人群为基础的研究显示，单纯的种族差异对子宫内膜癌的表现、病程和预后有着明确的影响。这些研究清楚地表明非洲裔美国人与其它人种相比，发病更严重，生存率更低。分析显示其原因是多因素的，并可能与获得医疗保健的不平等，与疾病相关的文化差异及疾病不同阶段的表现差异有关。实际上，在许多研究中，由于方法上的缺陷，如样本数太少，病因学是很难明确的。
G. Larry Maxwell是华盛顿特区Walter Reed军队医学中心妇产科医学博士。为了进一步研究非洲裔美国人和高加索人不同的原因，他和其他的研究者分析了1,151名患者的人口统计学和临床资料。这些患者均为三期、四期或复发的子宫内膜癌患者，并参加了上述四个随机、对照治疗的试验的任何一项。
作者证实了结果中的种族差异，即使在控制了临床表现和治疗之后。非洲裔美国人死于子宫癌的危险性比高加索人高出了26%，即使他们患有相似的疾病并接受相同的治疗。作者观察到“对治疗的反应进行分析，黑人体内的肿瘤似乎对试验中采用的每一种化疗方法反应都较差。”
从时间方面来分析，非洲裔美国人生存时间的中位数为10.6个月，而高加索人为12.2个月。其研究结果还显示，非洲裔美国人比高加索人更容易表现为更严重的疾病，包括乳头状浆液性的组织学改变，四期病变及更高的肿瘤分级。
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作者:admin@医学,生命科学 2011-08-22 17:20
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