PO.PS01.02 · 人群科学

2000-2022年Kaiser Permanente Northern California上皮性卵巢癌组织学类型按种族/族裔的分布

Epithelial ovarian cancer histotype distributions by race/ethnicity in Kaiser Permanente Northern California, 2000-2022

编号 3565 展板 15 时间 4/20 02:00–05:00 区域 Section 34 主讲 Jennifer Doherty, MS;PhD

分会场 Cancer Surveillance: Emerging Cancer Trends and Population Differences

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作者与单位 Authors & Affiliations

Jennifer Anne Doherty¹, Martin Koebel², Jia Li³, Laurie Grieshober¹, Valerie S. Lee⁴, Lisa Moy³, Juraj Kavecansky⁵, Lindsay Jane Collin⁶, Scarlett L. Gomez⁷, Elisa V. Bandera⁸, Lawrence H. Kushi⁹

¹University of Utah Huntsman Cancer Institute, Salt Lake City, UT,²Alberta Precision Laboratories, Edmonton, AB, Canada,³Kaiser Permanente Northern California, Pleasanton, CA,⁴Kaiser Permanente Northern California Division of Research, Oakland, CA,⁵Kaiser Permanente, Antioch, CA,⁶Emory University, Rollins School of Public Health, Salt Lake City, UT,⁷University of Califonia San Francisco, San Francisco, CA,⁸Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,⁹Director of Scientific Policy, Division of Research, Kaiser Permanente, Oakland, CA

摘要 Abstract

中文摘要

背景：2014年和2020年世界卫生组织（WHO）针对上皮性卵巢癌（EOC）的诊断分类指南标准化了组织学类型分类，改善了病理学家之间的可重复性，并揭示了按组织学类型的显著生存差异。尚未在人群水平上使用这些更新的指南按种族/族裔群体表征EOC组织学类型的分布。我们采用WHO 2020指南进行集中式病理复核，以表征Black、Hispanic、非西班牙裔（NH）Asian和Pacific Islander（API）以及NH white群体中EOC组织学类型的分布。方法：Kaiser Permanente卵巢癌生存研究纳入了6,067例于2000-2022年间诊断、年龄18岁及以上、并在Kaiser Permanente Northern California接受EOC治疗的病例。使用2020 WHO指南对其中2,470例的原始诊断切片子集进行集中复核（中位8张切片/患者，范围1-80）。20例的切片不含肿瘤，109例被判定并非EOC，剩余2,341例纳入分析。我们通过计算队列总体以及各种族/族裔群体的未加权Cohen's Kappa，评估复核前（原始诊断）与复核后EOC组织学类型分布的一致性。结果：总体而言，原始诊断与病理学家复核之间的组织学类型判定具有较高一致性（Kappa = 0.67）。一致性在各种族/族裔群体间存在差异，NH API（n=640）、Hispanic（n=522）和NH white群体（n=928）具有较高一致性（Kappa分别为0.73、0.67和0.61），而Black个体（n=242）为中等一致性（Kappa 0.59）。总体而言，研究复核前后各组织学类型的比例：高级别浆液性（HGSC）从58%升至62%；子宫内膜样从14%升至17%；低级别浆液性从2%升至3%；非特指性癌（NOS）从5%降至0.6%，包括混合型在内的归组罕见EOC组织学类型从4%降至2%；透明细胞、黏液性和癌肉瘤保持不变（分别为9%、4%和3%）。HGSC比例最高的是Black个体（73%），最低的是NH API个体（50%），Hispanic和NH white个体的患病率相似（分别为64%和66%）。子宫内膜样、透明细胞和黏液性组织学类型在NH API个体中更为常见（分别为23%、14%和6%），高于其他群体（分别为12-16%、6-8%和2-3%的范围）。结论：使用WHO 2020改善的组织学类型判定细化了按种族/族裔的组织学类型分布的显著差异。具体而言，Black个体更可能被诊断为侵袭性的HGSC组织学类型，而在NH API个体中非HGSC组织学类型更为常见，尤其是透明细胞、子宫内膜样和黏液性组织学类型。

查看英文原文 English abstract

Background: The 2014 and 2020 World Health Organization (WHO) diagnostic classification guidelines for epithelial ovarian cancer (EOC) standardized histotype classification, improved reproducibility across pathologists, and revealed distinct survival differences by histotype. EOC histotype distributions have not been characterized by racial/ethnic groups on a population level using these updated guidelines. We performed centralized pathology review using the WHO 2020 guidelines to characterize distributions of EOC histotypes across Black, Hispanic, non-Hispanic (NH) Asian and Pacific Islander (API), and NH white groups. Methods: The Kaiser Permanente Research on Ovarian Cancer Survival study includes 6,067 EOC cases ages 18 years and older diagnosed in 2000-2022 who received care for their EOC at Kaiser Permanente Northern California. Original diagnostic slides were centrally reviewed using 2020 WHO guidelines for a subset of 2,470 cases (median 8 slides/patient, range 1-80). Slides for 20 cases did not contain tumor, and 109 were determined not to be EOC, leaving 2,341 cases for analysis. We assessed concordance of the distribution of EOC histotypes before (original diagnosis) and after re-review by calculating unweighted Cohen's Kappa for the cohort overall, and separately for racial/ethnic groups. Results: Overall there was substantial agreement of histotype assignment between the original diagnosis and the pathologist's review (Kappa = 0.67). Agreement varied across racial/ethnic groups, with substantial agreement for NH API (n=640), Hispanic (n=522), and NH white groups (n=928; Kappas 0.73, 0.67, and 0.61, respectively), but moderate agreement for Black individuals (n=242; Kappa 0.59). Overall, proportions of the histotypes before and after study review increased for high grade serous (HGSC) from 58% to 62%; 14% to 17% for endometrioid; 2% to 3% for low grade serous; decreased for carcinoma, NOS from 5% to 0.6% and for grouped rare EOC histotypes including mixed from 4% to 2%; and were unchanged for clear cell, mucinous, and carcinosarcoma (9%, 4%, and 3%, respectively). The highest proportion of HGSC was among Black individuals (73%), and the lowest among NH API individuals (50%), with similar prevalences for Hispanic and NH white individuals (64% and 66%, respectively). Endometrioid, clear cell, and mucinous histotypes were more common among NH API individuals (23%, 14%, and 6%, respectively) compared with the other groups (ranges of 12-16%, 6-8%, and 2-3%, respectively). Conclusions: Improved histotype assignment using WHO 2020 refined distinct differences in histotype distributions by race/ethnicity. Specifically, Black individuals are more likely to be diagnosed with the aggressive HGSC histotype, whereas among NH API individuals non-HGSC histotypes were more common, specifically clear cell, endometrioid, and mucinous histotypes.

利益披露 Disclosure

J. A. Doherty, None.. J. Li, None.. L. Moy, None.

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