Neoadjuvant chemotherapy in ovarian cancer: Are there racial disparities in use and survival?
Menée aux Etats-Unis à partir de données 2004-2017 portant sur 37 566 patientes atteintes d'un cancer de l'ovaire de stade III/IV, cette étude analyse les disparités ethniques dans l'ordre et la nature des traitements reçus, puis analyse l'impact de ces disparités sur la mortalité
Background: We investigated racial and ethnic disparities in treatment sequence (i.e., neoadjuvant chemotherapy (NACT) plus interval debulking surgery (IDS) vs. primary debulking surgery (PDS) plus adjuvant chemotherapy) among ovarian cancer patients and its contribution to disparities in mortality. Methods: Study included 37,566 women aged ≥18 years, diagnosed with stage III/IV ovarian cancer from the National Cancer Database (2004–2017). Logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (CI) for racial and ethnic disparities in treatment sequence. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95%CI for racial and ethnic disparities in all-cause mortality. Results: Non-Hispanic Black (NHB) and Asian women were more likely to receive NACT plus IDS relative to PDS plus adjuvant chemotherapy than non-Hispanic White (NHW) women (OR: 1.12, 95% CI: 1.02–1.22 and OR: 1.12, 95% CI: 0.99–1.28, respectively). Compared to NHW women, NHB women had increased hazard of mortality (HR: 1.14, 95% CI: 1.09–1.20), whereas Asian and Hispanic women had a lower hazard of mortality (HR: 0.81, 95% CI: 0.74–0.88 and HR: 0.83, 95% CI: 0.77–0.88, respectively), which did not change after accounting for treatment sequence. Conclusions: NHB women were more likely to receive NACT plus IDS and experience a higher mortality rates than NHW women. Impact: Differences in treatment sequence did not explain racial disparities in ovarian cancer mortality. Further evaluation of racial and ethnic differences in treatment and survival in a cohort of patients with detailed treatment information is warranted.