Objective: A difference in survival rates between black and white patients with cancer of the corpus uteri is well established. This study was conducted to determine whether the overexpression of HER2/neu oncogene is ...Objective: A difference in survival rates between black and white patients with cancer of the corpus uteri is well established. This study was conducted to determine whether the overexpression of HER2/neu oncogene is associated with poor outcome in uterine serous papillary endometrial cancer, which is a highly aggressive variant of endometrial cancer, and whether a racial difference in the frequency of HER2/neu overexpression may contribute to the disparity in endometrial cancer survival. Study design: Immunohistochemical evaluation was used to examine HER2/neu expression in paraffin blocks from 27 women with stage IA to IV uterine serous papillary endometrial cancer. Univariable analysis was performed and followed by multivariable analysis with Cox’ s proportional hazard model to evaluate whether HER2/neu expression was associated with poor outcome in uterine serous papillary endometrial cancer. Results: Black patients tended to be younger (P =. 02) and have higher HER2/neu expression than white patients (trend P =. 02). Seven of 10 black patients (70% ) showed heavy (3+ ) expression, compared with 4 of 17 white patients (24% ; P =. 04). The association of heavy HER2/neu expression with race persisted after age was controlled through stratification (P =. 05). Earlier deaths from uterine serous papillary endometrial cancer were seen among heavy HER2/neu expressers (P =. 002), black patients (P =. 04), and patients ≤ 65 years old (P =. 04). However, multivariate Cox regression showed that short survival was associated significantly with heavy HER2/neu expression (P =. 02) but not with age (P =. 07) or race (P =. 35), which indicates that HER2/neu expression accounted for much of the race disparity in survival in this patient population. Conclusion: Overexpression of HER2/neu in uterine serous papillary endometrial cancer is an independent variable that is associated with poor outcome, occurs more frequently in black women, and may contribute to racial disparity in survival. HER2/neu expression may guide clinical treatment of patients with uterine serous papillary endometrial cancer and may have implications for the implementation of novel treatment strategies.展开更多
Background -Few studies have examined the association of race and outcomes after coronary artery bypass graft(CABG)surgery while controlling for both patient and hospital effects. Methods and Results -We retrospective...Background -Few studies have examined the association of race and outcomes after coronary artery bypass graft(CABG)surgery while controlling for both patient and hospital effects. Methods and Results -We retrospectively analyzed data on a cohort of 566 785 white and 24 354 black Medicare beneficiaries 65 years old and older undergoing CABG in 1091 US hospitals from 1997 to 2000. Mortality and repeat revascularization rates were examined after sequential adjustment for patient and hospital differences by use of generalized estimating equations. Unadjusted mortality was higher(P< 0.001) in black than in white patients at 30(6.4%versus 5.2%), 90(8.3%versus 6.6%), and 365 days(13.5%versus 9.8%) after surgery. Black patients were more likely(P< 0.001) to undergo CABG at hospitals with the highest mortality(56%versus 47%) and at hospitals in the lowest volume quintile(24%versus 20%). Adjusted only for patient characteristics, mortality was 8%, 11%, and 25%higher in black patients at 30, 90, and 365 days. After adjustment for hospital effects, 30 and 90 day mortality was similar but 17%higher in black patients at 365 days. Racial differences in mortality were greater in men than in women. On adjustment for patient and hospital effects, repeat revascularization rates were similar in black and white patients. Conclusions -Racial disparities in CABG outcomes are sensitive to the effects of sex and duration of postsurgical follow-up. The increasing disparity in outcomes as follow-up increased is consistent with the hypothesis that black patients have less access to secondary prevention and rehabilitation services after surgery.展开更多
文摘Objective: A difference in survival rates between black and white patients with cancer of the corpus uteri is well established. This study was conducted to determine whether the overexpression of HER2/neu oncogene is associated with poor outcome in uterine serous papillary endometrial cancer, which is a highly aggressive variant of endometrial cancer, and whether a racial difference in the frequency of HER2/neu overexpression may contribute to the disparity in endometrial cancer survival. Study design: Immunohistochemical evaluation was used to examine HER2/neu expression in paraffin blocks from 27 women with stage IA to IV uterine serous papillary endometrial cancer. Univariable analysis was performed and followed by multivariable analysis with Cox’ s proportional hazard model to evaluate whether HER2/neu expression was associated with poor outcome in uterine serous papillary endometrial cancer. Results: Black patients tended to be younger (P =. 02) and have higher HER2/neu expression than white patients (trend P =. 02). Seven of 10 black patients (70% ) showed heavy (3+ ) expression, compared with 4 of 17 white patients (24% ; P =. 04). The association of heavy HER2/neu expression with race persisted after age was controlled through stratification (P =. 05). Earlier deaths from uterine serous papillary endometrial cancer were seen among heavy HER2/neu expressers (P =. 002), black patients (P =. 04), and patients ≤ 65 years old (P =. 04). However, multivariate Cox regression showed that short survival was associated significantly with heavy HER2/neu expression (P =. 02) but not with age (P =. 07) or race (P =. 35), which indicates that HER2/neu expression accounted for much of the race disparity in survival in this patient population. Conclusion: Overexpression of HER2/neu in uterine serous papillary endometrial cancer is an independent variable that is associated with poor outcome, occurs more frequently in black women, and may contribute to racial disparity in survival. HER2/neu expression may guide clinical treatment of patients with uterine serous papillary endometrial cancer and may have implications for the implementation of novel treatment strategies.
文摘Background -Few studies have examined the association of race and outcomes after coronary artery bypass graft(CABG)surgery while controlling for both patient and hospital effects. Methods and Results -We retrospectively analyzed data on a cohort of 566 785 white and 24 354 black Medicare beneficiaries 65 years old and older undergoing CABG in 1091 US hospitals from 1997 to 2000. Mortality and repeat revascularization rates were examined after sequential adjustment for patient and hospital differences by use of generalized estimating equations. Unadjusted mortality was higher(P< 0.001) in black than in white patients at 30(6.4%versus 5.2%), 90(8.3%versus 6.6%), and 365 days(13.5%versus 9.8%) after surgery. Black patients were more likely(P< 0.001) to undergo CABG at hospitals with the highest mortality(56%versus 47%) and at hospitals in the lowest volume quintile(24%versus 20%). Adjusted only for patient characteristics, mortality was 8%, 11%, and 25%higher in black patients at 30, 90, and 365 days. After adjustment for hospital effects, 30 and 90 day mortality was similar but 17%higher in black patients at 365 days. Racial differences in mortality were greater in men than in women. On adjustment for patient and hospital effects, repeat revascularization rates were similar in black and white patients. Conclusions -Racial disparities in CABG outcomes are sensitive to the effects of sex and duration of postsurgical follow-up. The increasing disparity in outcomes as follow-up increased is consistent with the hypothesis that black patients have less access to secondary prevention and rehabilitation services after surgery.
