Uterine Cancer Survival Research Articles

Five-Year Relative Survival Rates of Women Diagnosed with Uterine Cancer by County-Level Socioeconomic Status Overall and across Histology and Race/Ethnicity.

Understanding socioeconomic factors contributing to uterine cancer survival disparities is crucial, especially given the increasing incidence of uterine cancer, which disproportionately impacts racial/ethnic groups. We investigated the impact of county-level socioeconomic factors on five-year survival rates of uterine cancer overall and by histology across race/ethnicity. We included 333,013 women aged ≥ 30 years with microscopically confirmed uterine cancers (2000-2018) from the Surveillance, Epidemiology, and End Results 22 database followed through 2019. Age-standardized five-year relative survival rates were compared within race/ethnicity and histology, examining the differences across tertiles of county-level percent (%) <high-school education, %<150 percent poverty, %unemployment, median household income, and %urbanicity. Overall age-adjusted five-year relative survival was 77.7%. Rates were lowest among those residing in the least advantaged counties (tertile 3) and highest among the most advantaged (tertile 1): education (74.7% vs. 80.2%), poverty (72.9% vs. 79.8%), unemployment (75.7% vs. 80.5%), and income (73.3% tertile 1 vs. 78.1% tertile 3). Impact of county-level socioeconomic characteristics on survival across histology was minimal. We observed considerable survival disparities among NH-Black and NH-Native American/Alaskan Native women, regardless of tumor and socioeconomic characteristics. These findings add to our understanding of how county-level socioeconomic characteristics affect uterine cancer survival inequalities among racial/ethnic groups.

The impact of nativity on uterine cancer survival in the public hospital system of Queens, New York

ObjectiveWe studied cis-women with uterine cancer presenting to the two Public Hospitals in Queens, New York from 2006 to 2015 to examine the relationship between nativity (birthplace) and survival. MethodsA retrospective review of tumor registries identified women diagnosed with uterine cancer between January 1, 2006, and December 31, 2015. Data from 259 women were available for this analysis. ResultsMost women were born outside the United States (US) (76% versus 24%). The majority of US-born women were black (68%). Seventy-seven women (30%) were born in Latin America, 76 in the Caribbean Islands (29%) and 44 in Asia/South Asia (17%). Most women presented with stage I/II disease (70%) and endometrioid/mucinous histology (68%) with no significant differences observed among nativity groups. Kaplan-Meier estimated survival curves stratified by birthplace demonstrated significant differences in survival distributions among the groups using the log-rank test (P < 0.0001). The most favorable survival curves were observed among all foreign-born women, whereas the least favorable survival was demonstrated in US-born women. Time to death was analyzed using the Cox proportional hazards model. Adjusting for age of diagnosis, insurance status, stage, and treatment modality, Latin American and Asia/South Asia birthplace was significantly associated with increased survival time. ConclusionAn immigrant health paradox was defined for foreign-born Latin American and Asian/South Asian women presenting to the two Public Hospitals of Queens, New York, as women born in these geographic regions were less likely to die at any given time compared to those born in the United States.

Healthcare access dimensions and uterine cancer survival: a national cancer database study.

Disparities exist throughout diagnosis, treatment, and survival for Black patients with uterine cancer. There is limited data on how several healthcare access (HCA) dimensions contribute to these disparities in patients with advanced stage uterine cancer. Using the National Cancer Database (NCDB), we identified patients aged 40-89 years with Stage III-IV uterine cancer between 2004-2015 who received chemotherapy and/or radiotherapy. Race/ethnicity were classified as non-Hispanic (NH)-Black, Hispanic, and NH-White. Variables defined in the NCDB were used to assess HCA affordability, availability, and accessibility. Kaplan-Meier estimates, log-rank test, and multivariable Cox proportional hazards models were used to analyze overall survival. Of 43,134 patients, 78.8% of the cohort identified as NH-White, 15.3% NH-Black, and 5.9% Hispanic. NH-Black patients were the most likely to have type II (75.6% vs. 53.9% and 55.4%) and stage IV (40.8% vs. 30.7% and 32.3%) disease compared to NH-White and Hispanic patients. NH-Black patients were more likely than NH-White and Hispanic patients to have government funded insurance (58.6% vs. 50.3% and 50.4%), live in low-income areas (46.4% vs. 14.2% and 29.9%), and receive only chemotherapy (53.5% vs. 43.1% and 46.2%). Having private insurance and receiving treatment at an academic facility were positive predictors of survival. NH-Black patients had worse survival than NH-White patients after adjusting for clinical characteristics and healthcare access dimensions (HR 1.29; 95% CI 1.24, 1.34). While HCA affordability and availability predicted survival in patients with advanced stage uterine cancer, additional factors contribute to racial disparities. Compared to NH-White patients, NH-Black patients had more aggressive disease, received only chemotherapy rather than combined therapy, and had worse survival regardless of cancer subtype. Additional dimensions of healthcare access must be explored to remedy uterine cancer disparities.

Defining the Oligometastatic State and Predicting Overall Survival in Uterine Cancers using a Recursive Partitioning Analysis: A National Cancer Database Analysis

Oligometastatic disease is an intermediate state between locoregional disease and widely metastatic disease. Studies have shown an overall survival advantage in oligometastatic patients treated aggressively in multiple cancers. However, few studies have explored this relationship in oligometastatic gynecological cancers. In this study, we sought to identify if an oligometastatic state with improved overall survival exists in uterine cancer and whether treatment patterns, or patient factors play a role in survival. The National Cancer Database was retrospectively analyzed in patients diagnosed with uterine cancer between 2004-2019. We excluded patients with non-metastatic disease at diagnosis, lack of metastatic sites listed, multiple primaries and missing survival data. Survival analyses were performed using Cox proportional hazards analyses and the Kaplan-Meier method and differences between groups were evaluated with log-rank tests. Recursive partitioning analysis (RPA) was performed using the rpart package in R. Amongst 641,276 women with uterine cancer, 17,343 were ultimately in our study population after exclusion who had a median age of 64 (range 18-90), median overall survival of 11.1 months, and a total of 24,337 metastases that represented the following metastatic sites: lung (35%), other (24%) (sites "other" than bone, brain liver or lung), liver (15%), bone (12%), distant lymph nodes (10%), brain (3%) and carcinomatosis (1%). Multivariate cox proportional hazards analysis identified the following variables as significantly associated with survival, which were then used for RPA: one metastatic site, treatment, grade, age, race, Charlson-Deyo score. The data was split 70/30% for training and validation, respectively. A survival model was built using RPA on the training data with 10-fold cross-validation and had accuracy of 76.25% (p = 3.393e-0.5). Survival prediction was performed on the internal validation data set with 76.69% accuracy (p = 0.004). RPA stratified 4 groups with the following median survivals: 5.9, 8.6, 29.5, and 43.8 months (log-rank test p<0.0001). The group with the best overall survival was defined by 1 metastatic site (carcinomatosis, distant lymph nodes and "other"), combination treatment with systemic therapy and radiation or surgery and low-grade histology. An oligometastatic state with involvement of one metastatic site does exist with improved survival in uterine cancer. The RPA defined groups may aid in identifying patients that are best suited for aggressive definitive combination therapy versus those that would be better suited for comfort care. Analysis is ongoing and will further delineate the relationship between specific treatment modalities and overall survival in patients with one metastatic site. This study may set the foundation for a prospective clinical trial.

Healthcare access dimensions and uterine cancer survival: A National Cancer Database study.

5594 Background: Racial disparities persist throughout the continuum of care for Black patients with uterine cancer. Few studies have evaluated how multiple dimensions of healthcare access (HCA) contribute to these disparities in patients who present at an advanced stage and meet criteria for adjuvant therapy. Methods: Patients with Stage III-IV uterine cancer between 2004-2015 who received adjuvant therapy with complete sociodemographic and other relevant covariate data were identified in the National Cancer Database (NCDB). Race and ethnicity were defined as non-Hispanic (NH)-Black, Hispanic, and NH-White. Healthcare access dimensions of affordability, availability and accessibility were measured using variables defined in the NCDB. Overall survival was analyzed using Kaplan-Meier curves, log-rank test, and multivariable Cox proportional hazard models. Results: The study cohort included 43,134 patients: 78.8% NH-White, 15.3% NH-Black, and 5.9% Hispanic. Compared to NH-White and Hispanic patients, NH-Black patients were more likely to have Type II (75.6% vs. 53.9% and 55.4%) and Stage IV disease (40.8% vs. 30.7% and 32.3%). NH-Black patients were more likely to receive chemotherapy alone (53.5% vs. 43.1% and 46.2%) compared to NH-White and Hispanic patients. NH-Black patients were the most likely to have government funded insurance (58.6% vs. 50.3% and 50.4%) and live in the lowest income quartile (46.4% vs. 14.2% and 29.9%) compared to NH-White and Hispanic patients. NH-Black patients had a significantly higher risk of death than NH-White patients when adjusting for demographic/clinical characteristics and all three healthcare access dimensions (HR 1.29; 95% CI 1.24, 1.34). Conclusions: Healthcare access affordability predicts survival but does not fully explain racial disparities in survival rates of patients with advanced stage uterine cancer. NH-Black patients are more likely to have aggressive disease, receive chemotherapy alone, and have worse survival than NH-White patients regardless of pathogenic subtype. Investigating additional healthcare access dimensions may be critical to addressing disparities in uterine cancer.

Interaction of race and socioeconomic status as risk modulators of treatment delay and cancer-specific mortality in uterine cancer.

5595 Background: The majority of studies of uterine cancer combine high and low-grade histologies and do not sample a diverse cohort of patients. In many studies race is treated as biologic construct, when it may be better thought of as a proxy for socioeconomic inequity and deprivation. Socioeconomic (SE) deprivation may play a significant role in the disease trajectory of women with uterine cancer. Methods: Data were drawn from the Metropolitan Detroit Cancer Surveillance System which covers a tri-county area of approximately 4 million people. We included non-Hispanic Black (NHB) and White (NHW) women diagnosed with uterine cancer between 2010 and 2018. Poorly differentiated and undifferentiated endometrioid, serous, clear cell, mixed, carcinosarcoma and mucinous histologies were considered high grade. Patients diagnosed by death certificate, or with unknown stage or histology were excluded. Socioeconomic status was assessed using the Yost Score, an area-level composite measure of socioeconomic deprivation derived from census-tract data at cancer diagnosis. Lower Yost quintile indicates higher deprivation. Competing risk analysis was used to determine risk of uterine cancer specific mortality (reported as subdistribution hazard ratio [SHR]) and to assess statistical interaction between race and Yost score. Results: A total of 4,840 patients were identified. Race conferred significant increased risk of cancer-specific mortality (SHR 2.11, p &lt; 0.0001). Race and Yost score interacted to increase risk of cancer-specific mortality in NHB women in the lowest Yost quintile (SHR 2.23, p &lt; 0.0001) compared to NHW and NHB women in the highest quintiles. The interaction between race and Yost score persisted only among women with low grade cancers (SHR 1.7, p = 0.04). Time from diagnosis to surgery increased as Yost score decreased. Women in the lowest Yost quintile had lower likelihood of receiving surgery within 6 weeks of diagnosis (OR 0.74, p = 0.001). This effect persisted among women with low grade cancer (NHB OR 0.75, p = 0.014; lowest Yost quintile OR 0.68, p &lt; 0.0001). An association between race, Yost score and delays in time to surgery was not seen among women with high grade cancers. Conclusions: Race and Yost score, an area-based measure of socioeconomic deprivation, are associated with increased cancer-specific mortality risk among women with low grade cancer. NHB race and high socioeconomic deprivation are associated with delayed primary surgery. The interaction between race and socioeconomic deprivation may underlie known disparities in uterine cancer survival, particularly in low grade disease where there is the greatest opportunity for timely curative surgery.

The impact of nativity on uterine cancer survival in the two public hospitals in Queens, New York

Objectives: We studied uterine cancer patients who presented to the two public hospitals in Queens, New York from 2006 to 2015 with the purpose of examining the relationship between nativity (birthplace) and survival. Methods: A retrospective review of tumor registries was used to identify patients diagnosed with uterine cancer between January 1, 2006 and December 31, 2015. Using electronic medical records, data from 260 patients were available for this analysis. Results: The majority of patients were born outside the United States (US) (76.2% versus 23.8%). The majority of US-born patients were BlackBlack (67.7%). Ninety-five patients (36.5%) were born in the Caribbean Islands, 59 in Latin America (22.7%) and 44 in Asia/South Asia (16.9%). Most patients presented with stage I/II disease (69.7%) and stage did not vary significantly by nativity. Endometrioid/mucinous histology (67.8%) was the most common followed by serous/clear cell (17.7%) and uterine sarcomas (11.4%) with no significant difference in histology among nativity groups. Kaplan-Meier estimated survival curves stratified by birthplace demonstrated significant differences in survival distributions among the groups using the log-rank test (P Download : Download high-res image (120KB) Download : Download full-size image Conclusions: A Latin American health paradox was defined for foreign-born Latino patients presenting to the two Public Hospitals of Queens, New York as patients born in Latin America were less likely to die at any given time compared to those born in the United States.

Evaluation of Aspirin Use With Cancer Incidence and Survival Among Older Adults in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

Many studies have evaluated the long-term benefits of aspirin use; however, the association of aspirin use with cancer incidence and survival in older individuals remains uncertain. Additional population-based evidence of this association is necessary to better understand any possible protective effects of aspirin in older adults. To investigate the association of aspirin use with risk of developing new cancers and site-specific cancer-associated survival in bladder, breast, esophageal, gastric, pancreatic, and uterine cancers. This cohort study used data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Participants were aged 65 years or older at baseline (1993-2001) or reached age 65 during follow-up. Data analysis was conducted from January to June 2020. Incidence of and survival from the investigated cancer types. Univariable and multivariable hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazards regression modeling, adjusting for covariates. Multivariable models for incidence included time-varying covariates. A total of 139 896 individuals (mean [SD] age at baseline, 66.4 [2.4] years; 71 884 [51.4%] women; 123 824 [88.5%] non-Hispanic White individuals) were included in the analysis. During the study period, 32 580 incident cancers (1751 [5.4%] bladder, 4552 [14.0%] breast, 332 [1.0%] esophageal, 397 [1.2%] gastric, 878 [2.7%] pancreatic, and 716 [2.2%] uterine cancers) were reported. Aspirin use was not associated with incidence of any of the investigated cancer types among individuals aged 65 years or older. Multivariable regression analysis demonstrated that aspirin use at least 3 times/week was associated with increased survival among patients with bladder (HR, 0.67; 95% CI, 0.51-0.88) and breast (HR, 0.75; 95% CI, 0.59-0.96) cancers but not among those with esophageal, gastric, pancreatic, or uterine cancer. A similar association of any aspirin use with bladder (HR, 0.75; 95% CI, 0.58-0.98) and breast (HR, 0.79; 95% CI, 0.63-0.99) cancer survival was observed. In the current study, any aspirin use and aspirin use at least 3 times/week was associated with improved bladder and breast cancer survival. Associations between aspirin use and incidence of any of the investigated cancers or between aspirin use and esophageal, gastric, pancreatic, or uterine cancer survival were not observed.

Sirtuin1 expression and survival in endometrial and clear-cell uterine cancer

Several risk factors like obesity and hyperlipidemia were described for endometrial cancer. Here, the nuclear NAD-dependent histone-deacetylase Sirtuin1 (SIRT1) seems to be important. SIRT1 is also involved in cell regulatory mechanisms and can serve as tumor promotor or suppressor. Its role in tumor biology is not clear yet. In this study, we evaluated and correlated the SIRT1 expression with patients’ tumor characteristics in endometrioid and clear-cell cancer of the uterus. 65 paraffin-embedded samples of patients with endometrial and clear-cell cancer of the uterus were immunohistochemically stained and SIRT1 expression was evaluated by immunoreactive score. The results were correlated to clinical and pathological tumor characteristics as well as to the expression of ARID1A and β-Catenin. The staining was significantly more intensive in uterine endometrioid carcinoma compared to uterine clear-cell carcinoma (p = 0.007). The expression of SIRT1 correlated significantly with the membranous expression of β-Catenin (p = 0.028) and ARID1A (p = 0.021). Patients with positive Sirtuin1 expression had a significantly better progression-free survival (p = 0.042), the overall survival showed a trend towards a better prognosis (p = 0.070). SIRT1 expression seems to be associated with improved progression-free survival in uterine cancer (endometrioid and clear-cell) and is correlated to the tumor suppressors β-Catenin and ARID1A. Further studies are necessary to elucidate the role of SIRT1 in uterine and ovarian cancer and its potential as a therapeutic target.

Advancing Uterine Cancer Survivorship Among African American Women

BackgroundFew studies have examined health behavior interventions for African American women who are uterine cancer survivors. Black-white differences in uterine cancer survival suggest that there are unmet needs among these survivors. MethodsThis article identifies opportunities to address disparities in uterine corpus cancer survival and quality of life, and thereby to increase uterine cancer survivorship among African American women. ResultsFor cancer survivors, common side effects, lasting for long periods after cancer treatment, include fatigue, loss of strength, lymphedema, and difficulty sleeping. A variety of interventions have been evaluated to address physical and mental health concerns, including exercise and dietary interventions. Considerable information exists about the effectiveness of such interventions for alleviating distress and improving quality of life among cancer survivors, but few studies have focused specifically on African American women with a uterine corpus cancer diagnosis. Research-tested culturally tailored lifestyle interventions are lacking. ConclusionsThere is a need for a better understanding of uterine cancer survivorship among African American women. Additional evaluations of interventions for improving the quality of life and survival of African American uterine cancer survivors are needed.

Influence of Body Mass Index on Tumor Pathology and Survival in Uterine Cancer: A Danish Register Study.

To evaluate the influence of body mass index (BMI) on endometrial tumor pathology, stage and complication rate and to identify individual prognostic factors, such as BMI, in types I and II endometrial cancer. Register study included all Danish women who underwent surgery for uterine cancer or atypical endometrial hyperplasia (International Classification of Diseases-10 codes D070, DC549) 2005 to 2012 (n = 6003). Impact of BMI on type I and II endometrial cancer survival. Danish Gynecological Cancer Database data on women with type I and II endometrial cancer were retrieved. Kaplan-Meier plot was used to illustrate differences in survival in relation to BMI. Log-rank test was used to demonstrate difference between the curves. Cox regression hazard model was used to estimate hazard ratios (HR) of the effect of BMI on overall survival. Four thousand three hundred thirty women were included. Women with type I cancer had a significantly better overall survival compared with those with type II cancer. Low BMI was associated with increased mortality in type I (HR, 2.07; 95% confidence interval [CI], 1.20-3.55), whereas in type II both low (HR, 1.68; 95% CI, 1.03-2.74) and high BMI (BMI, 30-35: HR, 1.54; 95% CI, 1.01-2.26 and BMI >40: HR, 2.15; 95% CI, 1.12-4.11) were significantly associated with increased mortality. Abnormal BMI is associated with increased mortality in subtypes of endometrial cancer. Underweight was associated with increased overall mortality in both types I and II, whereas obesity only disclosed a significant impact on overall mortality in type II.

Survival advantage of marriage in uterine cancer patients contrasts poor outcome for widows: A Surveillance, Epidemiology and End Results study

BackgroundMarriage confers a survival advantage for many cancers but has yet to be evaluated in uterine cancer patients. We sought to determine whether uterine cancer survival varied by self-reported relationship status. MethodsData were downloaded from the Surveillance, Epidemiology, and End Results program for women diagnosed with uterine cancer (between 1991 and 2010 in nine geographic regions). Patients with complete clinical data for analysis were categorized as married, single, widowed or other (divorced or separated). Differences in distributions were evaluated using Chi-square, exact and/or Mantel–Haenszel test. Uterine cancer survival was analyzed by Kaplan–Meier method with log-rank test and multivariate Cox regression analysis. ResultsOf 47,420 eligible patients, 56% were married, 15% were single and 19% were widows. Married vs. non-married women had a higher likelihood of having low risk (grade 1/2 endometrioid) endometrial cancer and local disease (p<0.0001), and a reduced risk of cancer death (HR=0.8, 95% CI=0.77–0.84). Multivariate evaluation of uterine cancer survival by relationship type indicated that widows consistently had significantly worse uterine cancer survival than single, married and other women in all patients and subset analyses (p<0.0001). ConclusionWhile marital status is associated with differential uterine cancer survival, evaluation of self-reported relationship by type indicated that the poor outcome observed in widows explained most of the benefit attributed to marriage. This report identifies widows as a new high-risk subpopulation with significantly inferior outcomes potentially benefiting from personalized care and social support.

Histopathologic differences account for racial disparity in uterine cancer survival

ObjectiveThe incidence for uterine cancers has been reported to be higher among white women, whereas mortality is higher among black women. Reasons for the higher mortality among black women are not completely understood. The aim of our study is to examine the relationship between race/ethnicity, histopathologic subtype, and survival in uterine cancer. MethodsWe abstracted socio-demographic, treatment, and survival data for all women who were diagnosed with uterine cancer at Montefiore Medical Center from January 1999 through December 2009. Pathology records were reviewed. Results984 patients were identified. Racial/ethnic distribution was 382 (39%) white, 308 (31%) black, 232 (24%) Hispanic, and 62 (6.3%) other races, mixed, or unknown. 592 (60%) patients had endometrioid histology. Blacks were much more likely than whites to have non-endometrioid histologies (p<0.001), including papillary serous, carcinosarcoma, and leiomyosarcoma. Blacks and Hispanics were at least as likely as whites to receive either chemotherapy or radiation therapy. The hazard ratio for death for black versus white patients was 1.94 (p<0.001) when all histological subtypes were included. The hazard ratio for Hispanics for death was 1.2 (p=0.32) compared to whites. However, when patients were divided into endometrioid and non-endometrioid histological subtypes, there was no significant difference in survival by race/ethnicity. ConclusionBlack patients with uterine cancer are much more likely to die and are much more likely to have non-endometrioid histologies than white patients. There are no differences in survival among white, black, or Hispanic women with uterine cancer, after control for histological subtype.

Insurance status and racial differences in uterine cancer survival: A study of patients in the National Cancer Database

Objective. To examine the impact of race and insurance on survival among a large cohort of uterine cancer patients from the National Cancer Database (NCDB). Methods. Women diagnosed with stages I–III uterine cancer between 2000 and 2001 were selected from the NCDB. Kaplan–Meier (KM) and multivariate Cox proportional hazards were used to estimate 4 year survival rates and hazard ratios (HR) and 95% confidence intervals (CIs), respectively. Results. Among the 39,510 evaluable patients, African Americans had a higher risk of death compared to whites (HR = 1.43 95% CI 1.31–1.56) after adjusting for age, clinical and facility factors and zip code level education. After additional adjustment for treatment, the risk death decreased among African Americans (HR = 1.33 95%CI 1.21–1.46) and subsequent adjustment for insurance further reduced the hazard of death (HR = 1.28 95% CI 1.17–1.40). Patients with insurance other than private had an increased risk of death (uninsured HR = 1.44 95% CI 1.20–1.72, Medicaid HR = 1.70, 95% CI 1.46–1.99, Medicare among patients aged 18–64 HR = 2.49, 95% CI 2.10–2.95, Medicare among patients aged 65–99 HR = 1.22, 95% 1.11–1.34). Conclusions. The largest contributors to African American/white survival disparities in this study were clinical factors, including stage at diagnosis, grade and histopathology. Patients without private health insurance had worse uterine cancer survival that may be improved through future health care reform aimed at improving access to preventive services and adequate treatment.

Abstract B87: The impact of insurance and treatment on racial differences in uterine cancer survival: A study of patients in the National Cancer Database

Abstract Introduction: Among uterine cancer patients, the age-adjusted mortality for African Americans is substantially higher relative to white patients. Previous studies have attributed this survival disparity to an elevated rate of aggressive tumors and advanced stage of disease among African Americans. However, the role of access to care in this racial disparity has not been fully elucidated. The aim of this study is to examine the impact of insurance status and treatment on racial/ethnic survival disparities among a large cohort of uterine cancer patients from the National Cancer Database (NCDB). Methods: Women diagnosed with stage I-III uterine cancer between 2000-2007 were selected from the NCDB. The association between race/ethnicity and all cause mortality was analyzed adjusting for patient demographic and clinical factors, health insurance, treatment (which included categories for no surgery, surgery alone, and surgery plus systemic treatment), area-level education, and facility characteristics. Kaplan Meir (KM) and multivariate Cox proportional hazards were used to estimate 4 year survival rates and hazard ratios (HR) and 95% confidence intervals (CI) among patients diagnosed between 2000-2002, respectively. Log binomial models were used to estimate risk ratios (RR) and 95% CI of likelihood of surgical treatment and among patients receiving surgery, the risk of lymphadectomy and systemic (radiation and/or chemotherapy) therapy. Results: Among the 178,891 evaluable patients, 73.79%, 4.39% 8.66%, 3.07% and 10.08% were white, Hispanic, African American, Other and missing race. The 4 year survival rate was 81.81% for whites, 81.50% for Hispanic, 63.19% for African American and 85.62% for other races. African Americans had a higher risk of death compared to whites (HR=1.43 95%CI1.31 −1.56) after adjusting for all covariates except treatment and insurance. After additional adjustment of treatment the risk death decreased among African Americans (HR=1.32 95%CI1.21 −1.45) and subsequent adjustment for insurance further reduced the hazard of death (HR=1.28 95% CI1.16-1.40). Patients with insurance other than private had an increased risk of death (Uninsured HR= 1.46 95%CI1.22-1.75, Medicaid HR=1.74,95%CI1.49-2.02, Medicare among patients aged 18-64 HR=2.52,95% CI 2.13-2.99, Medicare among patients aged 65-99 HR=1.26,95% 1.16-1.38). African Americans (RR= 0.96 95% CI 0.96-0.97) and Hispanics (RR=0.99 95% CI 0.99-1.00) had similar surgical treatment rates compared to whites and among patients receiving surgical treatment, similar rates of lymphadectomy and systemic treatment by race/ethnicity were observed. Conclusions: Our results suggest that a portion of the survival disparity between African Americans and whites is attributable to variations in access to care; the hazard ratios of death decreased 11% when treatment was accounted for and an additional 4% when insurance was accounted for. Despite accounting for these and other factors, African American patients had 32% greater risk of death. Future studies examining the role of lifestyle factors and non insurance related barriers to medical care, such as lower income, prior experiences and trust in the health care system, language and geographic barriers, cultural and communication barriers are warranted. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B87.

Disparities in Uterine Cancer Survival in a Brooklyn Cohort of Black Women

The present study evaluates uterine cancer survival in a black cohort living in Brooklyn and determines whether foreign-born women have a health benefit over those born in the USA. De-identified cancer registry data were obtained for all black patients (n = 311) diagnosed with primary uterine cancer between 1993 and 2007. Survival rates were analyzed according to place of birth. The 5-year survival rate was slightly higher for US-born black patients; the predictors of overall survival were different for foreign-born black women compared with US-born black women. Age was a predictor of death in US-born women and type of treatment was a predictor in foreign-born women. This study demonstrates that grouping together US-born and foreign-born black patients may mask important differences within the black population. The observed differences between US-born and foreign-born black patients may be associated with variations in environmental and other lifestyle exposures that contribute to more aggressive histologic types.

Influence of hospital procedure volume on uterine cancer survival in Osaka, Japan

Recent publications suggest that the relationships between hospital procedure volume and cancer survival may be different according to characteristics of the cancer such as primary site, extent of disease, and the year of diagnosis. The associations between hospital procedure volume and survival for uterine cancer, however, have never been studied in Japan. Data from the Osaka Cancer Registry were used to investigate this issue. Hospitals were ranked according to the number of operations for uterine cancer performed per year (high, medium, low, very low) in a diagnosis year period (1975-1981, 1982-1989 and 1990-1997). Survival analysis was carried out for the reported 7213 patients who lived in Osaka Prefecture (excluding Osaka City) diagnosed in 1975-1997, or patients who lived in Osaka City diagnosed in 1993-1997, because active follow-up data on vital status 5 years after diagnosis were available. The relative 5-year survival was higher with increased hospital procedure volume after 1982 (49.8, 68.6, 70.9, and 75.9%, respectively, in 1982-1989; 45.7, 62.7, 71.4, and 77.6%, respectively, in 1990-1997), and only survival in high-volume hospitals increased in the period 1975-1997. After adjustment for age, subsite, extent of disease and surgery by using the Cox regression model, patients receiving care in very low, low, or medium-volume hospitals were found to have a higher risk of death than patients receiving care in high-volume hospitals. Similar findings were obtained when the analysis was conducted separately for patients with cancer of the cervix and those with cancer of the corpus uteri. Although some limitations exist in this study, our results suggest that uterine cancer survival might be superior in high-volume hospitals in Osaka, Japan.