Endometrial carcinoma recurrence according to race and ethnicity: An NRG Oncology/Gynecologic Oncology Group 210 Study

Abstract

Non-Hispanic black (NHB) women are more likely to experience an endometrial carcinoma (EC) recurrence compared to non-Hispanic white (NHW) women. The extent to which tumor characteristics, socioeconomic status (SES) and treatment contribute to this observation is not well defined. In the NRG Oncology/Gynecology Oncology Group (GOG) 210 Study we evaluated associations between race/ethnicity and EC recurrence according to tumor characteristics with adjustment for potential confounders. Our analysis included 3,199 NHW, 532 NHB and 232 Hispanic women with EC. Recurrence was documented during follow-up. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between race/ethnicity and EC recurrence in models stratified by histologic subtype (low-grade endometrioid, high-grade endometrioid, serous, mixed cell, carcinosarcoma, clear cell) or stage (I, II, III) and adjusted for age, SES, body mass index, smoking status and treatment. In histologic subtype-stratified models, higher EC recurrence was noted in NHB women with low-grade endometrioid (HR = 1.94, 95% CI = 1.21-3.10) or carcinosarcomas (HR = 1.66, 95% CI = 0.99-2.79) compared to NHWs. In stage-stratified models, higher EC recurrence was noted among NHB women with stage I (HR = 1.48, 95% CI = 1.06-2.05) and Hispanic women with stage III disease (HR = 1.81, 95% CI = 1.11-2.95). Our observations of higher EC recurrence risk among NHB and Hispanic women, as compared to NHW women, were not explained by tumor characteristics, SES, treatment or other confounders. Other factors, such as racial differences in tumor biology or other patient factors, should be explored as contributors to racial disparities in EC recurrence.

Impact of Sociodemographic Characteristics on the Quality of Care in the Surgical Management of Endometrial Cancer: An Analysis of a National Database in the United States

“…The motivations of this lack of treatment are multiple: barriers in the patient-physician communication, patient belief, and rejection of cancer [13]. Moreover, it has been observed that patients of black ethnicity have a lower overall survival compared to white women, tumor characteristics aside [14]. However, we did not find that patients of "other" race (such as Hispanics) were more likely to receive the incorrect treatment [4].…”

Prospective cohort study of metabolic syndrome and endometrial cancer survival

“…The association between BMI and endometrial cancer recurrence was investigated by fifteen studies. 63,[67][68][69]72,[74][75][76]78,[82][83][84]86,90,92 In a French Multicenter Study, Canlorbe et al 68 68 Moreover, none of the other studies that assessed the association between BMI and endometrial cancer recurrence observed a statistically significant relationship in the main 63,67,75,76,[82][83][84]90,92 or stratified analyses by endometrial cancer type, 69,78 tumour histological subtype, 72 or cancer stage. Two studies previously assessed the association between pre-diagnosis blood glucose levels and overall survival among endometrial cancer survivors, reporting no statistically significant associations.…”

Receipt of adjuvant endometrial cancer treatment according to race: an NRG Oncology/Gynecologic Oncology Group 210 Study

“…Despite unclear mechanisms linking race with adjuvant treatment receipt, it is apparent that black women with EC continue to experience worse outcomes than their white counterparts (20, 34). In our NRG Oncology/GOG 210 Study population, black EC patients have significantly higher risks of all-cause mortality [hazard ratio (HR) =1.21], EC-specific mortality (HR=1.27), and recurrence risk (HR=1.36) (35).…”