Patterns and trends in the cause of death for patients with endometrial cancer

Abstract

Background Racial disparities in endometrial cancer have been reported in the United States, but trends and the underlying causes are not well understood. We aimed to examine the trends and contributing factors in racial disparities for causes of death among endometrial cancer patients. Method In this population-based cohort study, we identified 139 473 women diagnosed with first, primary endometrial cancer between 1992 to 2018 from Surveillance, Epidemiology, and End Results Program. We used Fine and Gray method to calculate the cumulative incidence of all-cause and specific-cause death. We used proportional subdistribution hazard (PSH) and cause-specific hazard (CSH) models to quantify the relative risk of Black-White disparities. We performed a mediation analysis to assess the contribution of potential factors to disparities. Results The cumulative incidence of all-cause death decreased in endometrial cancer patients, with estimates at 5-year of 26.72% in 1992–1996 and 22.59% in 2007–2011. Compared with White patients, Black patients persistently had an increased risk of death due to endometrial cancer (PSH HR = 2.05, 95% CI = 1.90 to 2.22; CSH HR = 2.19, 95% CI = 2.00 to 2.40), and causes other than endometrial cancer (PSH HR = 1.23, 95% CI = 1.10 to 1.37; CSH HR = 1.46, 95% CI = 1.31 to 1.63). Grade, histological subtype, surgery utilization, and stage at diagnosis explained 24.4%, 20.1%, 18.4%, and 16.6% of the Black-White disparity in all-cause death, respectively. Conclusions Although the cumulative incidence of all-cause death decreased, the Black-White gaps persisted in patients with endometrial cancer. Grade and histological subtype had the greatest influence. More efforts are needed to address the disparities.

Racioethnic Disparities in Endometrial Cancer Outcomes

“…The results showed a higher prevalence of serous EC (58% vs. 36%) and carcinosarcoma (25% vs. 16%), and a lower prevalence of endometrioid EC (17% vs. 48%) in black women [66]. A recent cohort analysis of the US SEER program concluded that EC grade and histological subtype explained 24.4% and 20.1% of the black-white EC mortality disparity, respectively [67]. In a separate analysis of the US National Cancer Database, the histologic subtype was deemed accountable for up to 56.2% of the excess relative risk among black patients with EC [68].…”

Race, Prevalence of POLE and POLD1 Alterations, and Survival Among Patients With Endometrial Cancer

“…There exists a large racial disparity in endometrial cancer (EC) mortality in the United States, with Black patients exhibiting a 5-year mortality rate approximately double that of White patients with EC . Poorer survival is associated with Black race, even after adjusting for surgery, histology, grade, age, stage at diagnosis, comorbid conditions, access to care, and socioeconomic factors . The Cancer Genome Atlas (TCGA) project identified 4 molecular subgroups of EC: DNA polymerase epsilon ( POLE ) ultra-altered, mismatch repair deficiency, copy-number (CN)–low, and CN-high .…”

“… 1 , 2 , 3 , 4 , 5 Poorer survival is associated with Black race, even after adjusting for surgery, histology, grade, age, stage at diagnosis, comorbid conditions, access to care, and socioeconomic factors. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 The Cancer Genome Atlas (TCGA) project identified 4 molecular subgroups of EC: DNA polymerase epsilon ( POLE ) ultra-altered, mismatch repair deficiency, copy-number (CN)–low, and CN-high. 15 , 16 More recent studies utilized immunohistochemistry staining for p53, finding that this is a cost-effective surrogate for identification of the CN-high group, which has the poorest prognosis.…”