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

A. S. Felix, T. M. Brasky, D. E. Cohn, D. G. Mutch, W. T. Creasman, P. H. Thaker, J. L. Walker, R. G. Moore, S. B. Lele, S. R. Guntupalli, Levi S Downs, Ci Nagel, J. F. Boggess, M. L. Pearl, O. B. Ioffe, W. Deng, D. S. Miller, L. A. Brinton

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1102-1115
Number of pages14
JournalInternational Journal of Cancer
Volume142
Issue number6
DOIs
StatePublished - Mar 15 2018

Bibliographical note

Funding Information:
1Division of Epidemiology, Ohio State University College of Public Health, Columbus, OH 2Division of Cancer Prevention and Control, Ohio State University College of Medicine, Columbus, OH 3Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH 4Washington University School of Medicine, St. Louis, MO 5Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 6Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma, OK 7Program in Women’s Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital/Brown University, Providence, RI 8Gynecologic Oncology [SBL] & NRG Statistics and Data Management Center [WD], Roswell Park Cancer Institute, Buffalo, NY 9Gynecologic Oncology, University of Colorado Cancer Center, Aurora, CO 10Gynecologic Oncology, University of Minnesota, Minneapolis, MN 11Gynecologic Oncology, Case Western Reserve University, Cleveland, OH 12Gynecologic Oncology Program, University of North Carolina, Chapel Hill, NC 13Gynecologic Oncology, State University of New York at Stony Brook, Stony Brook, NY 14Anatomical Pathology, University of Maryland, College Park, MD 15Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, TX 16Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD

Funding Information:
Key words: uterus neoplasm, racial disparities, outcomes, socioeconomic status, tumor heterogeneity Conflict of interest: Dr Cohn reported serving in an advisory/consulting role for Oncology Analytics; Dr Mutch reported serving in an advisory/consulting role for Lilly and paid to participate in a speakers’ bureau for AstraZeneca; Dr Thaker reported serving in an advisory/consulting role for Celsion and received funding from Merck; Dr Moore has received research funding from Angle, Inc., and Fujirebio Diagnostics; Dr Lele reported serving in an advisory/consulting role and receiving honoraria from Genetech; Dr Guntupalli reported serving in an advisory/consulting role and receiving honoraria from Genentech and Janssen and receiving funding from Bristol-Myers Squibb and Dr Pearl receives royalties from our research foundation on behalf of VitaTex. This work has nothing to do with this research article or GOG 210 in general. Grant sponsor: National Cancer Institute grants to the Gynecologic Oncology Group Administrative Office; Grant number: CA 27469; Grant sponsor: The Gynecologic Oncology Group Statistical and Data Center; Grant number: CA 37517; Grant sponsor: The NRG Oncology; Grant numbers: 1 U10 CA180822 and U10 CA180868; Grant sponsor: National Cancer Institute, National Institutes of Health DOI: 10.1002/ijc.31127 History: Received 27 June 2017; Accepted 4 Oct 2017; Online 24 Oct 2017 Correspondence to: Ashley Felix, 1841 Neil Avenue, 346 Cunz Hall, Columbus, OH 43210, USA, E-mail: felix.20@osu.edu; Tel: 11 6146881477

Funding Information:
The following institutions participated in our study: Roswell Park Cancer Institute, University of Alabama at Birmingham, Duke University Medical Center, Abington Memorial Hospital, Walter Reed Army Medical Center, Wayne State University, University of Minnesota Medical School, Northwestern University, University of Mississippi, University of Colorado-Anschutz Cancer Pavilion, University of California at Los Angeles, Fred Hutchinson Cancer Research Center, Penn State Milton S. Hershey Medical Center, University of Cincinnati, University of North Carolina, University of Iowa Hospitals and Clinics, University of Texas Southwestern Medical Center, Indiana University Medical Center, Wake Forest University Health Sciences, University of California Medical Center at Irvine – Orange Campus, Magee Women’s Hospital – University of Pittsburgh Medical Center, University of New Mexico, Cleveland Clinic Foundation, State University of New York at Stony Brook, Washington University School of Medicine, Cooper Hospital/University Medical Center, Columbus Cancer Council/Ohio State University, University of Massachusetts Memorial Health Care, Fox Chase Cancer Center, Women’s Cancer Center of Nevada, University of Oklahoma Health Sciences Center, University of Virginia, University of Chicago, Mayo Clinic, Case Western Reserve University, Moffitt Cancer Center and Research Institute, Yale University, University of Wisconsin Hospital, Women and Infants’ Hospital of Rhode Island, The Hospital of Central Connecticut at New Britain General, GYN Oncology of West Michigan, PLLC and Community Clinical Oncology Program.

Keywords

  • outcomes
  • racial disparities
  • socioeconomic status
  • tumor heterogeneity
  • uterus neoplasm

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