Racial, ethnic and country of origin disparities in aggressive endometrial cancer histologic subtypes

Stuart S Winkler; Chunqiao Tian; Yovanni Casablanca; Nicholas W Bateman; Suzanne Jokajtys; Calen W Kucera; Christopher M Tarney; John K Chan; Michael T Richardson; Daniel S Kapp; Cheng-I Liao; Chad A Hamilton; Charles A Leath 3rd; Megan Reddy; Michele L Cote; Timothy D O'Connor; Nathaniel L Jones; Rodney P Rocconi; Matthew A Powell; John Farley; Craig D Shriver; Thomas P Conrads; Neil T Phippen; G Larry Maxwell; Kathleen M Darcy

doi:10.1016/j.ygyno.2024.01.009

Racial, ethnic and country of origin disparities in aggressive endometrial cancer histologic subtypes

Gynecol Oncol. 2024 Jan 25:184:31-42. doi: 10.1016/j.ygyno.2024.01.009. Online ahead of print.

Authors

Stuart S Winkler¹, Chunqiao Tian², Yovanni Casablanca³, Nicholas W Bateman², Suzanne Jokajtys⁴, Calen W Kucera⁴, Christopher M Tarney⁴, John K Chan⁵, Michael T Richardson⁶, Daniel S Kapp⁷, Cheng-I Liao⁸, Chad A Hamilton⁹, Charles A Leath 3rd¹⁰, Megan Reddy¹¹, Michele L Cote¹², Timothy D O'Connor¹³, Nathaniel L Jones¹⁴, Rodney P Rocconi¹⁵, Matthew A Powell¹⁶, John Farley¹⁷, Craig D Shriver¹⁸, Thomas P Conrads¹⁹, Neil T Phippen⁴, G Larry Maxwell¹⁹, Kathleen M Darcy²⁰

Affiliations

¹ Division of Gynecologic Oncology, Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, TX, USA.
² Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA.
³ Division of Gynecologic Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
⁴ Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
⁵ Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA.
⁶ Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine, Los Angeles, CA. USA.
⁷ Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA.
⁸ Division of Obstetrics and Gynecology, Pingtung Veterans General Hospital, Pingtung, Taiwan.
⁹ Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA, USA.
¹⁰ Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL, USA.
¹¹ California Pacific Medical Center, San Francisco, CA, USA.
¹² Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN, USA.
¹³ Institute for Genome Sciences, Department of Medicine, Program in Personalized and Genomic Medicine, University of Maryland School of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
¹⁴ Division of Gynecologic Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA.
¹⁵ Division of Gynecologic Oncology, Cancer Center & Research Institute, The University of Mississippi Medical Center, Jackson, MS, USA.
¹⁶ Division of Gynecologic Oncology, Siteman Cancer Center, Washington University, St Louis, MO, USA.
¹⁷ Division of Gynecologic Oncology, Center for Women's Health, Cancer Institute, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
¹⁸ Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
¹⁹ Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA, USA.
²⁰ Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA. Electronic address: darcyk@whirc.org.

PMID: 38277919
DOI: 10.1016/j.ygyno.2024.01.009

Abstract

Objective: This study investigated the risk of an aggressive endometrial cancer (EC) diagnosis by race, ethnicity, and country of origin to further elucidate histologic disparities in non-Hispanic Black (NHB), Hispanic, Asian/Pacific Islander (API), American Indian/Alaskan Native (AIAN) vs. non-Hispanic White (NHW) patients, particularly in Hispanic or API subgroups.

Methods: Patient diagnosed between 2004 and 2020 with low grade (LG)-endometrioid endometrial cancer (ECC) or an aggressive EC including grade 3 EEC, serous carcinoma, clear cell carcinoma, mixed epithelial carcinoma, or carcinosarcoma in the National Cancer Database were studied. The odds ratio (OR) and 95% confidence interval (CI) for diagnosis of an aggressive EC histology was estimated using logistic modeling.

Results: There were 343,868 NHW, 48,897 NHB, 30,013 Hispanic, 15,015 API and 1646 AIAN patients. The OR (95% CI) for an aggressive EC diagnosis was 3.07 (3.01-3.13) for NHB, 1.08 (1.06-1.11) for Hispanic, 1.17 (1.13-1.21) for API and 1.07 (0.96-1.19) for AIAN, relative to NHW patients. Subset analyses by country of origin illustrated the diversity in the OR for an aggressive EC diagnosis among Hispanic (1.18 for Mexican to 1.87 for Dominican), Asian (1.14 Asian Indian-Pakistani to 1.48 Korean) and Pacific Islander (1.00 for Hawaiian to 1.33 for Samoan) descendants. Hispanic, API and AIAN patients were diagnosed 5-years younger that NHW patients, and the risk for an aggressive EC histology were all significantly higher than NHW patients after correcting for age. Insurance status was another independent risk factor for aggressive histology.

Conclusions: Risk of an aggressive EC diagnosis varied by race, ethnicity, and country of origin. NHB patients had the highest risk, followed by Dominican, South/Central American, Cuban, Korean, Thai, Vietnamese, and Filipino descendants.

Keywords: Country of origin; Disparities; Endometrial cancer; Ethnicity; Histologic subtypes; NCDB; Race; Uterine cancer.