The Impact of Racial Disparities on Outcome in Patients With Stage IIIC Endometrial Carcinoma: A Pooled Data Analysis
Patrich T, Wang Y, Elshaikh MA, Zhu S, Damast S, Li JY, Fields EC, Beriwal S, Keller A, Kidd EA, Usoz M, Jolly S, Jaworski E, Leung EW, Taunk NK, Chino J, Russo AL, Lea JS, Lee LJ, Albuquerque KV, and Hathout L. The Impact of Racial Disparities on Outcome in Patients With Stage IIIC Endometrial Carcinoma: A Pooled Data Analysis. Am J Clin Oncol 2023.
American journal of clinical oncology
OBJECTIVE: To report the impact of race on clinical outcomes in patients with stage IIIC endometrial carcinoma.
MATERIALS AND METHODS: A retrospective multi-institutional study included 90 black and 568 non-black patients with stage IIIC endometrial carcinoma who received adjuvant chemotherapy and radiation treatments. Overall survival (OS) and recurrence-free survival (RFS) were calculated by the Kaplan-Meier method. Propensity score matching (PSM) was conducted. Statistical analyses were conducted using SPSS version 27.
RESULTS: The Median follow-up was 45.3 months. black patients were significantly older, had more nonendometrioid histology, grade 3 tumors, and were more likely to have >1 positive paraaortic lymph nodes compared with non-black patients (all P <0.0001). The 5-year estimated OS and RFS rates were 45% and 47% compared with 77% and 68% for black patients versus non-black patients, respectively (P <0.001). After PSM, the 2 groups were well-balanced for all prognostic covariates. The estimated hazard ratios of black versus non-black patients were 1.613 (P value=0.045) for OS and 1.487 (P value=0.116) for RFS. After PSM, black patients were more likely to receive the "Sandwich" approach and concurrent chemoradiotherapy compared with non-black (P=0.013) patients.
CONCLUSIONS: Black patients have higher rates of nonendometrioid histology, grade 3 tumors, and number of involved paraaortic lymph nodes, worse OS, and RFS, and were more likely to receive the "Sandwich" approach compared with non-black patients. After PSM, black patients had worse OS with a nonsignificant trend in RFS. Access to care, equitable inclusion on randomized trials, and identification of genomic differences are warranted to help mitigate disparities.
Medical Subject Headings
Female; Humans; Retrospective Studies; Neoplasm Staging; Endometrial Neoplasms; Chemotherapy, Adjuvant; Lymph Nodes
ePub ahead of print