The role of histology on endometrial cancer survival disparities in diverse Florida

Abstract

Background Endometrial cancer (EC) mortality is particularly high among non-Hispanic Blacks and is twice that of non-Hispanic Whites. However, comparisons of EC survival outcomes by race/ ethnicity are often confounded by histology and grade. Here, we analyze EC survival disparities in multiracial Florida with a focus on EC types (1 and 2) and subtypes, defined according to histology and grade. Methods All 27,809 cases of EC diagnosed during 2005-2016 were obtained from the Florida Cancer Registry. Age-standardized, 5-year cause-specific survival by race/ethnicity and histological type were calculated. Fine and Gray competing risk regression was used to estimate subdistribution hazard ratios (sHRs) for associations between risk of death due to EC and potential predictive factors such as histology/grade, age, stage at diagnosis, and insurance. Results Type 2 EC accounted for only 38.7% of all incident EC-cases but 74.6% of all EC-deaths. Blacks were disproportionately affected by type 2 EC (57.6%) compared to Whites, Hispanics, and Asians (35.6%, 37.7%, and 43.0%, respectively). Age-adjusted 5-year survival for types 1 and 2 were 85.3% and 51.6%, respectively; however, there was wide variation within type 2 subtypes, ranging from 60.2% for mixed cell EC to as low as 30.1% for carcinosarcoma. In the multivariable model, Blacks with type 2 EC had a 23% higher risk of death due to EC (sHR: 1.23, 95%CI: 1.12-1.36) compared to Whites. Conclusions Population-based analyses should consider the histological heterogeneity of EC because the less common type 2 EC drives racial/ethnic survival disparities in EC. Black women have a higher proportion of more aggressive histological types and an overall higher risk of death due to EC than Whites. To the extent that some of these histological types may be

Histopathologic, Genetic and Molecular Characterization of Endometrial Cancer Racial Disparity

“…In general, they are less well differentiated and have worse prognoses than Type I tumors, and they are responsible for a disproportionate number of endometrial cancer deaths. The increased incidence of Type II compared with Type I tumors is consistent with the worse 5-year disease-specific survival of Black (51–57%), compared with White (65–67%), Hispanic (64–69%) and Asian (67–72%) endometrial cancer patients in a California registry study ( p < 0.0001) [ 12 , 21 ]. In a Florida registry study, Black endometrial cancer patients had a higher incidence of Type II tumors (57.6%) compared with White (35.6%), Hispanic (37.7%) and Asian (43.0%) endometrial cancer patients, and a 24% high risk of death due to endometrial cancer compared with white patients [ 21 ].…”

“…The increased incidence of Type II compared with Type I tumors is consistent with the worse 5-year disease-specific survival of Black (51–57%), compared with White (65–67%), Hispanic (64–69%) and Asian (67–72%) endometrial cancer patients in a California registry study ( p < 0.0001) [ 12 , 21 ]. In a Florida registry study, Black endometrial cancer patients had a higher incidence of Type II tumors (57.6%) compared with White (35.6%), Hispanic (37.7%) and Asian (43.0%) endometrial cancer patients, and a 24% high risk of death due to endometrial cancer compared with white patients [ 21 ]. A national population-based study of 35,850 young women (<50 years of age) with endometrial cancer found that the young Black patients (3903) had higher mortality compared with the young White patients [ 19 ].…”

Breast, Ovarian, and Uterine Cancer: Etiology, Pathophysiology, and Management- A Review

“…It was observed that 69.4% of the women's population were White women, out of which 64.4% were diagnosed with grade I type of uterine cancer. The grade II type of uterine cancer was exhibited at a higher proportion by 57.6% of Black women, followed by 43.0% in Asian women, 37.7% in Hispanic women, and 35.5% in white women 80 .…”

Immunohistochemical Markers in Endometrial Cancer

“…Moreover, cancer of the uterine body is the thirteenth deadliest cancer in the female population worldwide, with a mortality rate that is twice as high in regions of the world with a high or very high HDI compared with that in regions with a low or medium HDI [ 1 ]. The prognosis of endometrial cancer depends on the stage, histology, grade and ethnicity of the woman [ 2 ]. In fact, endometrial cancer mortality appears to be much higher in Black women than in Caucasian, Hispanic and Asian women, also because the former are significantly more frequently affected by endometrial cancer with a histology other than low-grade endometrioid, which is most often diagnosed at an early stage [ 2 ].…”

“…The prognosis of endometrial cancer depends on the stage, histology, grade and ethnicity of the woman [ 2 ]. In fact, endometrial cancer mortality appears to be much higher in Black women than in Caucasian, Hispanic and Asian women, also because the former are significantly more frequently affected by endometrial cancer with a histology other than low-grade endometrioid, which is most often diagnosed at an early stage [ 2 ].…”