Christopher M Tarney1, Chunqiao Tian2, Guisong Wang2, Elizabeth A Dubil3, Nicholas W Bateman1, John K Chan4, Mohamed A Elshaikh5, Michele L Cote6, Joellen M Schildkraut7, Craig D Shriver8, Thomas P Conrads9, Chad A Hamilton1, G Larry Maxwell10, Kathleen M Darcy11. 1. Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; John P Murtha Cancer Center, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States. 2. Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States. 3. Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; John P Murtha Cancer Center, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, VA, United States. 4. Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, United States. 5. Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, United States. 6. Oncology, Wayne State University, Karmanos Cancer Institute, Detroit, MI, United States. 7. Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States. 8. John P Murtha Cancer Center, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States. 9. Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; John P Murtha Cancer Center, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Inova Schar Cancer Institute, Inova Center for Personalized Health, Falls Church, VA, United States. 10. Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; John P Murtha Cancer Center, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Inova Schar Cancer Institute, Inova Center for Personalized Health, Falls Church, VA, United States; Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, VA, United States. Electronic address: George.maxwell@inova.org. 11. Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; John P Murtha Cancer Center, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States. Electronic address: darcyk@whirc.org.
Abstract
INTRODUCTION: Although black patients with endometrial cancer (EC) have worse survival compared with white patients, the interaction between age/race has not been examined. The primary objective was to evaluate the impact of age at diagnosis on racial disparities in disease presentation and outcome in EC. METHODS: We evaluated women diagnosed with EC between 1991 and 2010 from the Surveillance, Epidemiology, and End Results. Mutation status for TP53 or PTEN, or with the aggressive integrative, transcript-based, or somatic copy number alteration-based molecular subtype were acquired from the Cancer Genome Atlas. Logistic regression model was used to estimate the interaction between age and race on histology. Cox regression model was used to estimate the interaction between age and race on survival. RESULTS: 78,184 white and 8518 black patients with EC were analyzed. Median age at diagnosis was 3-years younger for black vs. white patients with serous cancer and carcinosarcoma (P<0.0001). The increased presentation of non-endometrioid histology with age was larger in black vs. white patients (P<0.0001). The racial disparity in survival and cancer-related mortality was more prevalent in black vs. white patients, and in younger vs. older patients (P<0.0001). Mutations in TP53, PTEN and the three aggressive molecular subtypes each varied by race, age and histology. CONCLUSIONS: Aggressive histology and molecular features were more common in black patients and older age, with greater impact of age on poor tumor characteristics in black vs. white patients. Racial disparities in outcome were larger in younger patients. Intervention at early ages may mitigate racial disparities in EC.
INTRODUCTION: Although black patients with endometrial cancer (EC) have worse survival compared with white patients, the interaction between age/race has not been examined. The primary objective was to evaluate the impact of age at diagnosis on racial disparities in disease presentation and outcome in EC. METHODS: We evaluated women diagnosed with EC between 1991 and 2010 from the Surveillance, Epidemiology, and End Results. Mutation status for TP53 or PTEN, or with the aggressive integrative, transcript-based, or somatic copy number alteration-based molecular subtype were acquired from the Cancer Genome Atlas. Logistic regression model was used to estimate the interaction between age and race on histology. Cox regression model was used to estimate the interaction between age and race on survival. RESULTS: 78,184 white and 8518 black patients with EC were analyzed. Median age at diagnosis was 3-years younger for black vs. white patients with serous cancer and carcinosarcoma (P<0.0001). The increased presentation of non-endometrioid histology with age was larger in black vs. white patients (P<0.0001). The racial disparity in survival and cancer-related mortality was more prevalent in black vs. white patients, and in younger vs. older patients (P<0.0001). Mutations in TP53, PTEN and the three aggressive molecular subtypes each varied by race, age and histology. CONCLUSIONS: Aggressive histology and molecular features were more common in black patients and older age, with greater impact of age on poor tumor characteristics in black vs. white patients. Racial disparities in outcome were larger in younger patients. Intervention at early ages may mitigate racial disparities in EC.
Authors: Jared R Robbins; Omar H Gayar; Mark Zaki; Meredith Mahan; Thomas Buekers; Mohamed A Elshaikh Journal: Gynecol Oncol Date: 2013-10-11 Impact factor: 5.482
Authors: Sara H Olson; Coral L Atoria; Michele L Cote; Linda S Cook; Radhai Rastogi; Robert A Soslow; Carol L Brown; Elena B Elkin Journal: Cancer Epidemiol Biomarkers Prev Date: 2012-03-16 Impact factor: 4.254
Authors: H Aziz; M Rotman; F Hussain; G Smith; E Chan; K Choi; C Sohn; J Halpern; D Schwartz; I Aral Journal: Int J Radiat Oncol Biol Phys Date: 1993-09-30 Impact factor: 7.038
Authors: Nicholas W Bateman; Christopher M Tarney; Tamara S Abulez; Brian L Hood; Kelly A Conrads; Ming Zhou; Anthony R Soltis; Pang-Ning Teng; Amanda Jackson; Chunqiao Tian; Clifton L Dalgard; Matthew D Wilkerson; Michael D Kessler; Zachary Goecker; Jeremy Loffredo; Craig D Shriver; Hai Hu; Michele Cote; Glendon J Parker; James Segars; Ayman Al-Hendy; John I Risinger; Neil T Phippen; Yovanni Casablanca; Kathleen M Darcy; G Larry Maxwell; Thomas P Conrads; Timothy D O'Connor Journal: iScience Date: 2021-12-23