Racial disparities in survival for high-grade uterine cancer: a Surveillance, Epidemiology and End Results analysis

Abstract

Objectives: Endometrial cancer is the most common cancer of the female reproductive organs. The American Cancer Society estimates that at least 12,000 deaths in 2020 will be attributable to endometrial cancer. The purpose of this study was to identify any racial disparities in cancer-specific survival for women with high-grade endometrial cancer as well any prognostic factors that may affect survival. Methods: We performed a retrospective analysis of women aged 18 years and older using the Surveillance, Epidemiology, and End Results Database (SEER) for the years 2007-2015, extracting cases of high-grade (Type 2) endometrial cancer. Baseline characteristics were compared using the Chi-squared test (Table 1). Unadjusted and adjusted Cox-regressions were used to model the association between race and survival at one- and five-year post-diagnosis, calculating hazard ratios (HR) and 95% confidence intervals (CI). Results: A total of 12,262 women met the study eligibility criteria and were included in the analysis. Baseline characteristics showed that the proportion of women who were uninsured was highest amongst Hispanic (5.6%) and Non-Hispanic (NH) Black women (4.7%). The proportion of women who were diagnosed at FIGO stage IV with distant metastasis was highest amongst NH American Indian women (8.9%), followed by Hispanic women (7.6%), and NH Black women (6.7%). The incidence of more aggressive histological subtypes such as serous carcinoma (29.9%) and carcinosarcoma (15.9%) was higher in NH Black compared to NH White women. When adjusting for covariates (age, insurance, marital status, histology, FIGO stage, summary stage, and lymph nodes), Hispanic women had the lowest 1-year survival amongst other groups when compared to NH White women (adjusted HR 1.78, 95% CI: 1.45-2.18), while NH Black women also had decreased survival (adjusted HR 1.49, 95% CI: 1.22-1.82). Regarding 5-year survival, Hispanic women had a 30% increased hazard of mortality when compared to White women (95% CI: 1.21-1.40), while NH Black women also had lower 5-year survival than White women (adjusted HR 1.19, 95% CI: 1.11-1.27). Notably, women who were older (70+), unmarried, had Medicaid, stage IV cancer with distant metastasis, and positive lymph nodes at diagnosis had decreased survival at 5 years. Conclusions: Racial disparities in high-grade endometrial cancer survival clearly exist with Hispanic and NH Black women having lower 1-year and 5-year cancer-specific survival when compared with NH White women. These disparities existed after controlling for factors such as age, insurance status, histological subtype, and stage. NH Black women have a higher incidence of more aggressive subtypes, uninsured status, and stage IV cancer, all of which could contribute to this disparity. Endometrial cancer is the most common cancer of the female reproductive organs. The American Cancer Society estimates that at least 12,000 deaths in 2020 will be attributable to endometrial cancer. The purpose of this study was to identify any racial disparities in cancer-specific survival for women with high-grade endometrial cancer as well any prognostic factors that may affect survival. We performed a retrospective analysis of women aged 18 years and older using the Surveillance, Epidemiology, and End Results Database (SEER) for the years 2007-2015, extracting cases of high-grade (Type 2) endometrial cancer. Baseline characteristics were compared using the Chi-squared test (Table 1). Unadjusted and adjusted Cox-regressions were used to model the association between race and survival at one- and five-year post-diagnosis, calculating hazard ratios (HR) and 95% confidence intervals (CI). A total of 12,262 women met the study eligibility criteria and were included in the analysis. Baseline characteristics showed that the proportion of women who were uninsured was highest amongst Hispanic (5.6%) and Non-Hispanic (NH) Black women (4.7%). The proportion of women who were diagnosed at FIGO stage IV with distant metastasis was highest amongst NH American Indian women (8.9%), followed by Hispanic women (7.6%), and NH Black women (6.7%). The incidence of more aggressive histological subtypes such as serous carcinoma (29.9%) and carcinosarcoma (15.9%) was higher in NH Black compared to NH White women. When adjusting for covariates (age, insurance, marital status, histology, FIGO stage, summary stage, and lymph nodes), Hispanic women had the lowest 1-year survival amongst other groups when compared to NH White women (adjusted HR 1.78, 95% CI: 1.45-2.18), while NH Black women also had decreased survival (adjusted HR 1.49, 95% CI: 1.22-1.82). Regarding 5-year survival, Hispanic women had a 30% increased hazard of mortality when compared to White women (95% CI: 1.21-1.40), while NH Black women also had lower 5-year survival than White women (adjusted HR 1.19, 95% CI: 1.11-1.27). Notably, women who were older (70+), unmarried, had Medicaid, stage IV cancer with distant metastasis, and positive lymph nodes at diagnosis had decreased survival at 5 years. Racial disparities in high-grade endometrial cancer survival clearly exist with Hispanic and NH Black women having lower 1-year and 5-year cancer-specific survival when compared with NH White women. These disparities existed after controlling for factors such as age, insurance status, histological subtype, and stage. NH Black women have a higher incidence of more aggressive subtypes, uninsured status, and stage IV cancer, all of which could contribute to this disparity.