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 Article

Full Text via DOI: 10.1016/j.ygyno.2024.03.026 Web of Science: 001226627300001

Cited authors

  • Kopelman ZA, Tian CQ, Tumas J, Phippen NT, Tarney CM, Hope ER, Winkler SS, Jokajtys S, Kucera CW, Chan JK, Richardson MT, Kapp DS, Hamilton CA, Leath CA III, Jones NL, Rocconi RP, Farley JH, Secord AA, Cosgrove CM, Powell MA, Klopp A, Walker JL, Fleming GF, Bateman NW, Conrads TP, Maxwell GL, Darcy KM

Abstract

  • 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% con fidence 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. (c) 2024 Elsevier Inc. All rights reserved.

Publication date

  • 2024

Published in

International Standard Serial Number (ISSN)

  • 0090-8258

Number of pages

  • 12

Start page

  • 103

End page

  • 114

Volume

  • 183