Endometrial carcinoma in Black vs Asian women: Racial disparities and opportunities to improve survival in 219,301 patients in the USA.
Authors: Henry Alberto Becerra, Nosakhare Paul Ilerhunmwuwa, Mustafa Wasifuddin, Ifeanyi Uche, Juan C. Osorio, Jen Chin C. Wang
Journal: Journal of Clinical Oncology (2024)

5608 Background: Endometrial Carcinoma (EC) is the most prevalent gynecological malignancy in the USA (1,2). Incidence and mortality has been increasing, making it a growing public health problem (2-4). While hysterectomy-corrected studies have revealed racial differences for EC (5,6), factors that influence the poor prognosis among black women with EC in the USA remain. The objective of this study is to describe sociodemographic characteristics, survival outcomes and prognostic factors based on race in EC patients. Methods: Cases of EC from the Surveillance, Epidemiology, and End Results (SEER) Research Plus Data, 17 Registries, from 2000 to 2020, were analyzed in SPSS v25. Variables were compared with Chi-squared test. Median Overall Survival (OS) was done using Kaplan-Meier method. Cox Regression analysis was done to identify independent prognostic factors influencing survival. A two-sided p-value ≤0.05 was considered statistically significant. Results: 219,301 patients with EC were included. Median follow up: 64 months. Median age of diagnosis: 62 years. 69.5% were whites, 8.6% blacks and 8.4% asians. Treatments were surgery (91.8%), radiotherapy (26.1%) and chemotherapy (18.1%). The median OS was 209 months (95%CI:207.1-210.9). Notably, the shortest median OS was observed in blacks (118 months), followed by 205 months for whites, while it was not reached for asians. Multivariate analysis showed that, compared to whites, blacks exhibit the poorest prognosis (HR=1.39, 95%CI:1.35-1.43), whereas asians demonstrated the most favorable prognosis across all races (HR=0.88, 95%CI:0.85-0.91). Independent poor prognostic factors found for EC included older age, low income and advanced stage. Differences in the distribution of these factors were observed among races. When comparing to asians, there was a higher proportion of blacks ≥60 years-old (66.9% vs 44%, p&lt;0.001), with incomes &lt;$60,000 (31.3% vs 3.6%, p&lt;0.001) and diagnosed at more advanced stage (37.4% vs 28.9%, p&lt;0.001). Surgery-based treatments showed the best prognosis (HR&lt;0.3 independent of race, p&lt;0.01). However, the distribution of these treatments stratified by race and stage showed that asians were more prone to receive surgical treatment independent of stage compared to blacks (p&lt;0.001). Conclusions: Our findings contribute novel information on distribution of prognostic factors across races and their impact on survival. Notably, compared to asians, blacks appear to face delayed diagnosis, lower income, and less frequent use of surgery-based treatments. This highlights the importance of early access to diagnosis and treatment as potential avenues to improve survival. Limitations include the lack of other potential prognostic factors such as obesity in the database. References (PMID):1. 37147968; 2. 33127429; 3. 34277441; 4. 27741565; 5. 35511145; 6. 31116674.