TY - JOUR
T1 - Disease progression, survival, and molecular disparities in Black and White patients with endometrioid endometrial carcinoma in real-world registries and GOG/NRG oncology randomized phase III clinical trials
AU - Kopelman, Zachary A.
AU - Tian, Chunqiao
AU - Tumas, Jordyn
AU - Phippen, Neil T.
AU - Tarney, Christopher M.
AU - Hope, Erica R.
AU - Winkler, Stuart S.
AU - Jokajtys, Suzanne
AU - Kucera, Calen W.
AU - Chan, John K.
AU - Richardson, Michael T.
AU - Kapp, Daniel S.
AU - Hamilton, Chad A.
AU - Leath, Charles A.
AU - Jones, Nathaniel L.
AU - Rocconi, Rodney P.
AU - Farley, John H.
AU - Secord, Angeles Alvarez
AU - Cosgrove, Casey M.
AU - Powell, Matthew A.
AU - Klopp, Ann
AU - Walker, Joan L.
AU - Fleming, Gini F.
AU - Bateman, Nicholas W.
AU - Conrads, Thomas P.
AU - Maxwell, G. Larry
AU - Darcy, Kathleen M.
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/4
Y1 - 2024/4
N2 - Objective: Investigate racial disparities in outcomes and molecular features in Black and White patients with endometrioid endometrial carcinoma (EEC). Methods: Black and White patients diagnosed with EEC who underwent hysterectomy ± adjuvant treatment in SEER, National Cancer Database (NCDB), the Genomics Evidence Neoplasia Information Exchange (GENIE) project (v.13.0), and eight NCI-sponsored randomized phase III clinical trials (RCTs) were studied. Hazard ratio (HR) and 95% confidence interval (CI) were estimated for cancer-related death (CRD), non-cancer death (NCD), and all-cause death. Results: Black (n = 4397) vs. White (n = 47,959) patients in SEER had a HR (95% CI) of 2.04 (1.87–2.23) for CRD and 1.22 (1.09–1.36) for NCD. In NCDB, the HR (95% CI) for death in Black (n = 13,468) vs. White (n = 155,706) patients was 1.52 (1.46–1.58) dropping to 1.29 (1.23–1.36) after propensity-score matching for age, comorbidity, income, insurance, grade, stage, LVSI, and treatment. In GENIE, Black (n = 109) vs. White (n = 1780) patients had fewer PTEN, PIK3R1, FBXW7, NF1, mTOR, CCND1, and PI3K-pathway-related gene mutations. In contrast, TP53 and DNA-repair-related gene mutation frequency as well as tumor mutational burden-high status were similar in Black and White patients. In RCTs, Black (n = 187) vs. White (n = 2877) patients were more likely to have advanced or recurrent disease, higher grade, worse performance status and progressive disease. Risk of death in Black vs. White patients in RCTs was 2.19 (1.77–2.71) persisting to 1.32 (1.09–1.61) after matching for grade, stage, and treatment arm while balancing age and performance status. Conclusions: Differences exist in clinical presentation, outcomes, and molecular features in Black vs. White patients with EEC in real-world registries and RCTs. Targeted-drug development, strategies to modify social determinants, and diverse inclusion in RCTs are approaches to reduce disparities.
AB - Objective: Investigate racial disparities in outcomes and molecular features in Black and White patients with endometrioid endometrial carcinoma (EEC). Methods: Black and White patients diagnosed with EEC who underwent hysterectomy ± adjuvant treatment in SEER, National Cancer Database (NCDB), the Genomics Evidence Neoplasia Information Exchange (GENIE) project (v.13.0), and eight NCI-sponsored randomized phase III clinical trials (RCTs) were studied. Hazard ratio (HR) and 95% confidence interval (CI) were estimated for cancer-related death (CRD), non-cancer death (NCD), and all-cause death. Results: Black (n = 4397) vs. White (n = 47,959) patients in SEER had a HR (95% CI) of 2.04 (1.87–2.23) for CRD and 1.22 (1.09–1.36) for NCD. In NCDB, the HR (95% CI) for death in Black (n = 13,468) vs. White (n = 155,706) patients was 1.52 (1.46–1.58) dropping to 1.29 (1.23–1.36) after propensity-score matching for age, comorbidity, income, insurance, grade, stage, LVSI, and treatment. In GENIE, Black (n = 109) vs. White (n = 1780) patients had fewer PTEN, PIK3R1, FBXW7, NF1, mTOR, CCND1, and PI3K-pathway-related gene mutations. In contrast, TP53 and DNA-repair-related gene mutation frequency as well as tumor mutational burden-high status were similar in Black and White patients. In RCTs, Black (n = 187) vs. White (n = 2877) patients were more likely to have advanced or recurrent disease, higher grade, worse performance status and progressive disease. Risk of death in Black vs. White patients in RCTs was 2.19 (1.77–2.71) persisting to 1.32 (1.09–1.61) after matching for grade, stage, and treatment arm while balancing age and performance status. Conclusions: Differences exist in clinical presentation, outcomes, and molecular features in Black vs. White patients with EEC in real-world registries and RCTs. Targeted-drug development, strategies to modify social determinants, and diverse inclusion in RCTs are approaches to reduce disparities.
KW - AACR GENIE
KW - Endometrioid endometrial cancer
KW - NCDB
KW - Racial disparities
KW - Randomized phase III clinical trial
KW - SEER
UR - http://www.scopus.com/inward/record.url?scp=85189443546&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2024.03.026
DO - 10.1016/j.ygyno.2024.03.026
M3 - Article
C2 - 38593674
AN - SCOPUS:85189443546
SN - 0090-8258
VL - 183
SP - 103
EP - 114
JO - Gynecologic oncology
JF - Gynecologic oncology
ER -