TY - JOUR
T1 - Disparities in cancer-specific and overall survival in black women with endometrial cancer
T2 - A Medicare-SEER study
AU - Saris, Daniel H.
AU - Smith, Anna Jo Bodurtha
AU - Brensinger, Colleen
AU - Kim, Sarah H.
AU - Haggerty, Ashley F.
AU - Latif, Nawar
AU - Cory, Lori
AU - Giuntoli, Robert L.
AU - Morgan, Mark A.
AU - Lin, Lilie L.
AU - Ko, Emily M.
N1 - Funding Information:
Grant 124268-IRG-78–002-35-IRG from the American Cancer Society (PI: Ko, E.M.) and by the George and Emily McMichael Harrison Fund, Penn Presbyterian Harrison Fund of the University of Pennsylvania Hospital Obstetrics and Gynecology Department (PI: Ko, E.M.), and a Donation in-kind to the University of Pennsylvania Department of Radiation Oncology (PI: Lin, L.)
Publisher Copyright:
© 2022 The Authors
PY - 2022/4
Y1 - 2022/4
N2 - Objectives: To examine overall survival (OS) and cancer-specific survival (CSS) for different racial groups of women with surgically staged endometrial cancer by histologic subtype. Methods: This is a retrospective cohort study of women with stage I-III endometrioid, serous, clear cell, and carcinosarcoma who underwent hysterectomy as primary surgical staging in the 2000–2016 SEER-Medicare database. OS and CSS outcomes were stratified by race (defined as White, Black, Other), stage, and histology. Survival was assessed with descriptive analyses, log-rank tests and unadjusted and adjusted multivariable cox regression models. Results: Of the 24,142 women identified, 85.5% were White, 8.5% Black, and 6% other races. Receipt of adjuvant therapy differed only for stage III endometrioid: Black women were less likely to receive adjuvant treatment after hysterectomy (61.2% vs. 70.1% White, p = 0.03). For stage I, Black women had worse CSS for all histologies other than clear cell in unadjusted and adjusted analyses. For stage II, Black women had worse CSS for endometrioid histology in unadjusted analyses and similar OS. For stage III, Black women with endometrioid carcinoma had worse CSS and OS in unadjusted analyses, but no significant difference in CSS in adjusted analyses. “Other” race showed improved OS for Stage I endometrioid adenocarcinoma without significant differences in outcomes when compared to White women. Conclusion: Across histologies other than clear cell, Black women diagnosed with stage I endometrial cancer had consistently worse CSS, despite similar receipt of adjuvant therapy. Differences in CSS and OS at higher stages disappeared once accounting for treatment disparities.
AB - Objectives: To examine overall survival (OS) and cancer-specific survival (CSS) for different racial groups of women with surgically staged endometrial cancer by histologic subtype. Methods: This is a retrospective cohort study of women with stage I-III endometrioid, serous, clear cell, and carcinosarcoma who underwent hysterectomy as primary surgical staging in the 2000–2016 SEER-Medicare database. OS and CSS outcomes were stratified by race (defined as White, Black, Other), stage, and histology. Survival was assessed with descriptive analyses, log-rank tests and unadjusted and adjusted multivariable cox regression models. Results: Of the 24,142 women identified, 85.5% were White, 8.5% Black, and 6% other races. Receipt of adjuvant therapy differed only for stage III endometrioid: Black women were less likely to receive adjuvant treatment after hysterectomy (61.2% vs. 70.1% White, p = 0.03). For stage I, Black women had worse CSS for all histologies other than clear cell in unadjusted and adjusted analyses. For stage II, Black women had worse CSS for endometrioid histology in unadjusted analyses and similar OS. For stage III, Black women with endometrioid carcinoma had worse CSS and OS in unadjusted analyses, but no significant difference in CSS in adjusted analyses. “Other” race showed improved OS for Stage I endometrioid adenocarcinoma without significant differences in outcomes when compared to White women. Conclusion: Across histologies other than clear cell, Black women diagnosed with stage I endometrial cancer had consistently worse CSS, despite similar receipt of adjuvant therapy. Differences in CSS and OS at higher stages disappeared once accounting for treatment disparities.
KW - Demographics
KW - Disparities
KW - Endometrial Cancer
KW - Outcomes
KW - SEER Medicare
KW - Survival
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U2 - 10.1016/j.gore.2022.100922
DO - 10.1016/j.gore.2022.100922
M3 - Article
C2 - 35242979
AN - SCOPUS:85124901055
SN - 2211-338X
VL - 40
JO - Gynecologic Oncology Reports
JF - Gynecologic Oncology Reports
M1 - 100922
ER -