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

Ashley S. Felix, David E. Cohn, Theodore M. Brasky, Richard Zaino, Kay Park, David G. Mutch, William T. Creasman, Premal H. Thaker, Joan L. Walker, Richard G. Moore, Shashikant B. Lele, Saketh R. Guntupalli, Levi S. Downs, Christa I. Nagel, John F. Boggess, Michael L. Pearl, Olga B. Ioffe, Marcus E. Randall, Louise A. Brinton

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background: Black women with endometrial cancer are more likely to die of their disease compared with white women with endometrial cancer. These survival disparities persist even when disproportionately worse tumor characteristics among black women are accounted. Receipt of less complete adjuvant treatment among black patients with endometrial cancer could contribute to this disparity. Objective: We assessed the hypothesis that black women with endometrial cancer are less likely than their white counterparts to receive adjuvant treatment within subgroups defined by tumor characteristics in the NRG Oncology/Gynecology Oncology Group 210 Study. Study Design: Our analysis included 615 black and 4283 white women with endometrial cancer who underwent hysterectomy. Women completed a questionnaire that assessed race and endometrial cancer risk factors. Tumor characteristics were available from pathology reports and central review. We categorized women as low-, intermediate-, or high-risk based on the European Society for Medical Oncology definition. Adjuvant treatment was documented during postoperative visits and was categorized as no adjuvant treatment (54.3%), radiotherapy only (16.5%), chemotherapy only (15.2%), and radiotherapy plus chemotherapy (14.0%). We used polytomous logistic regression to estimate odds ratios and 95% confidence intervals for multivariable-adjusted associations between race and adjuvant treatment in the overall study population and stratified by tumor subtype, stage, or European Society for Medical Oncology risk category. Results: Overall, black women were more likely to have received chemotherapy only (odds ratio, 1.40; 95% confidence interval, 1.04–1.86) or radiotherapy plus chemotherapy (odds ratio, 2.01; 95% confidence interval, 1.54–2.62) compared with white women in multivariable-adjusted models. No racial difference in the receipt of radiotherapy only was observed. In tumor subtype-stratified models, black women had higher odds of receiving radiotherapy plus chemotherapy than white women when diagnosed with low-grade endometrioid (odds ratio, 2.04; 95% confidence interval, 1.06–3.93) or serous tumors (odds ratio, 1.81; 95% confidence interval, 1.07–3.08). Race was not associated with adjuvant treatment among women who had been diagnosed with other tumor subtypes. In stage-stratified models, we observed no racial differences in the receipt of adjuvant treatment. In models that were stratified by European Society for Medical Oncology risk group, black women with high-risk cancer were more likely to receive radiotherapy plus chemotherapy compared with white women (odds ratio, 1.41; 95% confidence interval, 1.03–1.94). Conclusion: Contrary to our hypothesis, we observed higher odds of specific adjuvant treatment regimens among black women as compared with white women within specific subgroups of endometrial cancer characteristics.

Original languageEnglish (US)
Pages (from-to)459.e1-459.e11
JournalAmerican journal of obstetrics and gynecology
Volume219
Issue number5
DOIs
StatePublished - Nov 2018

Bibliographical note

Funding Information:
Supported by National Cancer Institute grants to the Gynecologic Oncology Group Administrative Office (CA 27469), the Gynecologic Oncology Group Statistical and Data Center (CA 37517) and the NRG Oncology Grant number: 1 U10 CA180822 and U10 CA180868. In addition, this research was supported in part by funds provided by the intramural research program of the National Cancer Institute, National Institutes of Health.

Funding Information:
The authors acknowledge the significant contributions of the late Dr D. Scott McMeekin who worked extensively on the GOG-210 study and Drs Wei Deng and Shamshad Ali for their contributions to the GOG-210 study. The following institutions participated in this 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.

Publisher Copyright:
© 2018 Elsevier Inc.

Keywords

  • adjuvant treatment
  • endometrial cancer
  • racial differences
  • tumor heterogeneity

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