Does race impact uterine cancer surgical treatment: An SGO Clinical Outcomes Registry analysis (056)

Abstract

<b>Objectives:</b> The age-adjusted mortality due to endometrial cancer (EC) among Black women (BW) is approximately 84% higher than it is for White women (WW). Multiple analyses of national registry data have revealed that BW with EC are more likely to receive guideline-discordant care. The objective of this study was to determine whether BW with EC in the SGO Clinical Outcomes Registry (SGO-COR) received surgical treatment differing from that of WW. <b>Methods:</b> The SGO-COR was comprised of validated clinical data from 29 SGO-COR centers collected between 2014 and 2018. Statistical analysis was performed using student's t-test and Chi-square with Stata v.14. A p-value of <0.05 was used for statistical significance. <b>Results:</b> In this cohort of 6984 total EC patients, 4338 underwent surgical management. Of those, 287 (6.6%) were Black, and 3792 (87%) were White. There was no difference in mean BMI (36.9 vs 36; p=0.86) or prevalence of diabetes (31% vs 26%; p=0.07) between BW and WW, but BW were more likely to be ASA >class II than WW (219/274, 80% vs 1921/3593, 53.4%; p<0.00001). Additional clinical data can be found in Table 1. BW were more likely to have > stage I disease (182/287, 63% vs 2980/3792, 78.5%; p<0.0001), non-endometrioid histology (135/287, 47% vs 702/3792, 18.5%; p<0.00001) and grade 3 disease (110/287, 38.3% vs 785/3792, 20.7%, p<0.00001). WW with stage I disease were more likely to undergo minimally invasive surgery (MIS) than BW with stage I disease (2693/2930, 91.9% vs 144/172, 83.7%, p=0.00019) as well as sentinel lymph node assessment (1004/2980, 33.6% vs 29/182, 16% p<0.00001). There was no difference in conversion to laparotomy between the groups (14/254, 5.5% for BW vs 116/3594, 3.2% for WW; p=0.05). There was no statistical difference in pelvic or para-aortic lymphadenectomy regardless of stage in BW versus WW. There were no differences in gross residual disease among BW and WW (9/223, 4% vs 2.1%, p=0.07). There was no difference in the rate of postoperative complications between BW versus WW. <b>Conclusions:</b> These SGO-COR results reflect several known trends, including BW being more likely to present with more advanced, higher-grade EC and non-endometrioid histology than WW. Contrary to previous studies, BW and WW received the same surgical care in some domains (rate of lymphadenectomy, presence of residual disease, rate of complications) but were less likely to be offered an MIS approach or undergo sentinel lymph node mapping. This may reflect that the Black women with EC in this dataset already overcame a major barrier to care by obtaining access to an SGO-COR center and likely a gynecologic oncologist. The disparity in MIS and sentinel node assessment may reflect the more advanced-stage and aggressive histologies noted in BW relative to WW, but provider biases resulting in this difference should also be addressed. This study is limited by an under-representation of Black patients relative to the general US population.