Cancer Medicine (Sep 2018)
Racial disparities in outcomes for high‐grade uterine cancer: A California cancer registry study
Abstract
Abstract Background Endometrial cancer (EC) is the most common gynecologic malignancy. We examined factors affecting overall prognosis and survival among different racial groups diagnosed with high‐grade EC. Methods We utilized the California Cancer Registry database (CCR) to identify women with high‐grade II EC from 1998 to 2009. Using the Kaplan‐Meier method, we described disease‐specific survival. Survival by stage, race, and time to treatment category was compared using the log‐rank test. The associations of race with disease‐specific survival were modeled using Cox proportional hazards regression. Covariates were selected a priori. Results A total of 10 647 patients met study eligibility criteria. The majority of patients in this cohort of high‐grade EC were non‐Hispanic (NH) white (64.1%), followed by Hispanic (15.7%), Asian (10.4%), and NH black (9.8%). NH black women had higher incidence of certain aggressive histologic subtypes in comparison with NH whites, including serous carcinomas and carcinosarcoma. Non‐Hispanic black patients had a worse 5‐year disease‐specific survival (DSS) when compared to other racial groups. The five‐year DSS for NH black women was 54% (51%‐57%), compared to NH white women 66% (65%‐67%), Hispanic 67% (64%‐69%), and Asians 69% (67%‐72%) (P < 0.0001). This clear survival disadvantage of NH black women persisted when controlling for other factors. Conclusions Non‐Hispanic black women have a higher incidence of more aggressive histologic subtypes even among a cohort of women high‐grade EC and have a disproportionately worse disease‐specific survival after controlling for factors such as age, histologic subtype, stage, time to treatment, and type of treatment.
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