A Matched Analysis on the Prognostic Impact of Race on Survival Endpoints of Women with Early-Stage Endometrial Cancer

Abstract

Objective: To compare survival endpoints between African American (AA) and non-AA (NAA) women with endometrial carcinoma (EC) stage I–II using a robust matching analysis. Methods and Materials: Patients were matched by stage, grade, adjuvant management (surveillance, vaginal brachytherapy or pelvic radiation treatment), age, and year of hysterectomy. Recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) were calculated. Results: A total of 758 patients were included. Body mass index and Age-Adjusted Charlson comorbidity index was significantly higher in AA compared to NAA women. There were no significant differences between the AA and NAA groups in regard to 5-year RFS (94 vs. 93%), DSS (96 vs. 98%) or 5-year OS (90 vs. 92%). On multivariate analysis of survival endpoints for the entire study cohort, it was found that race (AA vs. NAA) was not a significant predictor of RFS, DSS, or OS. Grade 3 tumors and the presence of lymphovascular space invasion (LVSI) were the only 2 independent predictors of RFS and DSS, while age-adjusted Charlson comorbidity score, grade 3, stage II and the presence of LVSI were independent predictors of shorter OS. Conclusions: When matched based on the tumor stage, grade, adjuvant treatment, age, and year of surgery, our study suggests that there is no statistically significant difference in any survival endpoints between AA and NAA women with early-stage EC. Based on these data, disparities in outcome likely do not stem from uterine cancer-related causes. The increased comorbidity burden in AA women is likely a factor contributing to the racial disparity in endometrial cancer.

Guideline‐adherent treatment, sociodemographic disparities, and cause‐specific survival for endometrial carcinomas

“…Additionally, Black and NHPI women had worse survival compared with White women, whereas Asian women had improved survival compared with White women. The literature indicates that Black women are more likely to have an advanced stage at diagnosis and more aggressive tumors than other racial/ethnic groups, which could shape differences observed in overall survival 1,2,9,15,30,31,32,33 . Although our review of the literature did not identify any studies specific to NHPI women, few noted Asian/Pacific Islander women having higher grade tumors and less favorable histologic types compared with White women 15,33,34 .…”

“…Although we observed that Black women in our study were more likely to have advanced stage and more aggressive grade of disease and histologic subtypes, the findings presented here point to the need for further research that unpacks how social, clinical, and epigenetic factors may shape persistent racial/ethnic disparities in survival. Although differences in tumor biology are an important clinical factor to consider, research also needs to explore the structural inequalities that exist for Black individuals (ie, experiences of racism, economic inequalities, and inadequate access to and quality of health care) and the influence these inequalities have on subsequent poorer health outcomes and decreased survival compared with Whites 1,2,9,30,32,35 . Future research should also consider and explore structural inequalities in addition to clinical characteristics for other racial/ethnic minority groups.…”

“…Uterine cancer is the most common gynecologic malignancy among women in the United States 1‐4 . Endometrial carcinomas represent the most common form of uterine cancer and among those, over 80% are diagnosed at an early stage and low grade 1,5,6 . Uterine cancer incidence in the United States has steadily risen over the last few decades, 7 increasing 14.5% from 2006 to 2016 8 .…”

Development and validation of tumor‐size‐stratified prognostic nomograms for patients with uterine sarcoma: A SEER database analysis

“…A study on racial disparities in women with uterine cancer suggests that black race patients have more aggressive histological types and higher tumor grade when compared to white race patients 21 . In addition, molecular differences and socioeconomic differences may also be important factors to interpret the racial disparity 21–24 . One of the possible reasons that single women have poor prognosis is that women's choice of treatment decisions is affected by marital status.…”

“… 21 In addition, molecular differences and socioeconomic differences may also be important factors to interpret the racial disparity. 21 , 22 , 23 , 24 One of the possible reasons that single women have poor prognosis is that women's choice of treatment decisions is affected by marital status. For example, the results of one study showed that the unmarried group was less likely to receive radiotherapy, chemotherapy, and surgery than the married group.…”