Racial Disparities in Type II Endometrial Cancer in the United States Pubblico

Abstract

Background: Population-based studies concerning racial disparities in type II endometrial cancer (EC) remain limited. Our study was designed to investigate racial disparities in the incidence trends, clinical presentation, treatment and survival of type IIEC. 

Method: TypeIIEC cases diagnosed between 2004 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) 18 Registries. Racial differences in age-adjusted incidence rates, annual percentage change (APC), clinicopathological characteristics, and five-year relative survival rates were examined. A multivariate Cox proportional hazards model was fit to identify potential independent predictors for overall survival (OS) and cause-specific survival (CS).

Results:A total of 35,906 type IIEC cases were included in this study. Age-adjusted incidence rates for type IIEC increased significantly for non-Hispanic Blacks, non-Hispanic Others and Hispanics (APC, 1.87, 1.62, and 1.42, respectively), and remained stable for non-Hispanic Whites. Compared with non-Hispanic Whites, non-Hispanic Blacks had a significantly higher overall incidence rate of type IIEC (incidence rate ratio [IRR] and 95% confidence interval [CI]:1.89[1.83, 1.94]), whilenon-Hispanic Others (IRR and 95% CI: 0.89[0.85, 0.92]) and Hispanics (IRR and 95% CI: 0.91[0.88, 0.94])had significantly lower overall incidence rates.Non-Hispanic Black patients were more likely to be diagnosed with advanced stage (46.4% vs. 39.7%, p<0.0001), were less likely to receive hysterectomy (84.1% vs 89.9%, p<0.0001), adequate lymphadenectomy (37.9% vs. 47.9%, p<0.0001) and radiation (36.9% vs. 40.3%, p<0.0001), and were more likely to receive chemotherapy (48.4% vs. 43.0%, p<0.0001), compared with non-Hispanic Whites. After adjusting for age at diagnosis, diagnosis period, histologic subtype, stage, hysterectomy, extent of lymphadenectomy, radiation, and chemotherapy, non-Hispanic Blacks had significantly worse OS (hazard ratio [HR] and 95% CI: 1.24[1.18, 1.30]) and CS (HR and 95% CI: 1.23[1.17, 1.30]) compared with non-Hispanic Whites. 

Conclusions:The overall incidence of type IIEC over the 12-year period increased in all racial/ethnic groups other than non-Hispanic Whites. Compared with non-Hispanic Whites, non-Hispanic Blacks demonstrated a considerably higher risk of type IIEC, while non-Hispanic Others and Hispanics exhibited considerably lower levels of risk. Non-Hispanic Blacks had worse OS and CS after controlling for clinical covariates compared with other racial/ethnic groups.

Table of Contents

Chapter I: Background/Literature Review…………………………………………....1

Introduction………………………………………………………………………………………..2

Factors concerning racial disparity in endometrial cancer…………………………………...........3

  Incidence and mortality………………………………………………………………………....3

  Clinical presentation…………………………………………………………………………….4

  Treatment………………………………………………………………………………………..5

  Molecular and genetic factors…………………………………………………………………...7

Social determinants……………………………………………………………………………...9

Comorbidity……………………………………………………………………………………10

Research associated with racial disparity in type IIendometrial cancer………………………….10

Conclusion………………………………………………………………………………………..12

Chapter II: Manuscript………………………………………………………………...13

Abstract…………………………………………………………………………………………...14

Introduction……………………………………………………………………………………….15

Material and Methods…………………………………………………………………………….17

Results…………………………………………………………………………………………….20

Discussion………………………………………………………………………………………...27

References………………………………………………………………………………………...36

Tables……………………………………………………………………………………………..47

Figures…………………………………………………………………………………………….52

Chapter III: Summary/Public Health Implications/Possible Future Directions…...58

Summary………………………………………………………………………………………….59

Public health implications………………………………………………………………………...59

Possible future directions…………………………………………………………………………60

Appendices………………………………………………………………………………61

Supplementary tables……………………………………………………………………………..61

Supplementary figures……………………………………………………………………………70

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Oncology Health Sciences, Epidemiology Health Sciences, Obstetrics and Gynecology
Parola chiave	SEER type II endometrial cancer racial disparity
Committee Chair / Thesis Advisor	Ward, Kevin C., Emory University

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