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Papatla K, Orfanelli T, Stoffels G, Layne T, Baldwin E, Leibold A, Blank SV, Cohen S. Mitigating disparity?: Treatment patterns, survival, and recurrence rates by race, ethnicity, and hospital site across a large urban health system. Gynecol Oncol Rep 2024; 53:101372. [PMID: 38584803 PMCID: PMC10997945 DOI: 10.1016/j.gore.2024.101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
Objective National data have shown worse endometrial cancer (EC) outcomes among racial and ethnic minorities. We aimed to analyze EC patient outcomes within a large urban academic health system, with a focus on patterns of care and recurrence rates. Methods This was a retrospective chart review of EC patients at three system hospitals from 1/1/07-12/31/17. Demographic and clinical factors, including time from EMB to surgery, rate of chemotherapy completion, persistent or recurrent disease, and palliative care referrals were extracted. Descriptive statistics and survival curves were generated. Analysis was done using SAS version 9.4. Results Black patients had lower overall survival compared to all others on univariate analysis only (p < 0.0001). Hospital site was associated with OS, with the academic anchor and satellite 1 having higher rates of all-cause mortality compared to satellite 2 (HR 4.68 academic anchor, 95 % CI 1.72-12.76, HR 5.36 satellite 1, 95 % CI 1.85-15.52). Time from EMB to surgery and rates of persistent disease following primary treatment were higher in Black patients. After adjusting for stage and grade, chemotherapy completion rate was significantly associated with race. Palliative care was utilized more for Black than White patients after adjusting for stage and grade (p = 0.005). Conclusions Racial disparities in EC are caused by a complex web of interconnected factors that ultimately lead to worse outcomes in Black women. While precision medicine has helped to close the gap, social determinants of health should be addressed, and models focusing on the complex interactions between biologic, genetic, and social factors should be utilized.
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Affiliation(s)
- Katyayani Papatla
- Icahn School of Medicine at the Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Gynecologic Oncology, New York, NY, United States
| | - Theofano Orfanelli
- Stony Brook Medicine, Department of Obstetrics, Gynecology, and Reproductive Medicine, Division of Gynecologic Oncology, Stony Brook, NY, United States
| | | | - Tracy Layne
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Elena Baldwin
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Aurora Leibold
- Mount Sinai West, Department of Obstetrics, Gynecology, and Reproductive Science New York, NY, United States
| | - Stephanie V. Blank
- Icahn School of Medicine at the Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Gynecologic Oncology, New York, NY, United States
| | - Samantha Cohen
- Icahn School of Medicine at the Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Gynecologic Oncology, New York, NY, United States
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Tetteh DA, Dai Z. Making Sense of Gynecologic Cancer: A Relational Dialectics Approach. Health Commun 2024:1-13. [PMID: 38528375 DOI: 10.1080/10410236.2024.2333112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
This study used the relational dialectics theory (RDT) as a theoretical lens to examine how the interplay of competing discourses shaped meaning making about gynecologic cancer. A reflexive thematic analysis of the narratives of 12 survivors of cervical cancer, ovarian cancer, and uterine cancer in Arkansas showed two discursive struggles at play, including continuity of care versus change, and voicing versus repressing of feelings. The findings showed that long history of care with physicians contributed to how participants privileged the discourse of continuity of care when faced with a decision to travel for care or receive care locally. We also found that cultural discourses about concealing women's cancer-afflicted bodies, lack of supportive spaces for women to discuss side effects of cancer treatments, and appropriate communication behavior between patients and physicians shaped the interplay of the discursive struggle of voicing versus repressing. The findings extend the RDT by showing that geographic location, disease characteristics, history of care between patients and physicians, and prevailing cultural discourses can contribute to the interplay of discursive struggles in the gynecologic cancer context. Further, the findings suggest to healthcare professionals to address harmful discourses about gynecologic cancer to help create support avenues for survivors.
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Affiliation(s)
| | - Zehui Dai
- School of Communication, Radford University
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Fife AJ, Najor AJ, Aspir TB, Haines KE, Vilardo NA, Isani SS, Cowan M, Gressel GM, Ye KQ, Nevadunsky NS, Kuo DY, Lin KY. Reduced healthcare access contributes to delay of care in endometrial cancer. Gynecol Oncol 2024; 182:115-120. [PMID: 38262233 DOI: 10.1016/j.ygyno.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/16/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE We aimed to characterize delays to care in patients with endometrioid endometrial cancer and the role healthcare access plays in these delays. METHODS A chart review was performed of patients with endometrioid endometrial cancer who presented with postmenopausal bleeding at a diverse, urban medical center between 2006 and 2018. The time from symptom onset to treatment was abstracted from the medical record. This interval was subdivided to assess for delay to presentation, delay to diagnosis, and delay to treatment. RESULTS We identified 484 patients who met the inclusion criteria. The median time from symptom onset to treatment was 4 months with an interquartile range of 2 to 8 months. Most patients had stage I disease at diagnosis (88.6%). There was no significant difference in race/ethnicity or disease stage at time of diagnosis between different groups. Patients who had not seen a primary care physician or general obstetrician-gynecologist in the year before symptom onset were more likely to have significantly delayed care (27.7% vs 14.3%, p = 0.02) and extrauterine disease (20.2% vs 4.9%, p < 0.01) compared to those with established care. Black and Hispanic patients were more likely to experience significant delays from initial biopsy to diagnosis. CONCLUSIONS Delays exist in the evaluation of endometrial cancer. This delay is most pronounced in patients without an established outpatient primary care provider or obstetrician-gynecologist.
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Affiliation(s)
- Alexander J Fife
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY 10461, United States of America.
| | - Anna J Najor
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY 10461, United States of America
| | - Tori B Aspir
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY 10461, United States of America
| | - Kaitlin E Haines
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY 10461, United States of America
| | - Nicole A Vilardo
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY 10461, United States of America
| | - Sara S Isani
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY 10461, United States of America
| | - Matthew Cowan
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY 10461, United States of America
| | - Gregory M Gressel
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY 10461, United States of America; Division of Gynecologic Oncology, Spectrum Health Cancer Center, 145 Michigan St NE, Suite 6300, Grand Rapids, MI 49503, United States of America
| | - Kenny Q Ye
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, Block Building Room 310, Bronx, NY 10461, United States of America
| | - Nicole S Nevadunsky
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY 10461, United States of America
| | - Dennis Y Kuo
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY 10461, United States of America
| | - Ken Y Lin
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY 10461, United States of America
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Ayodele A, Obeng-Gyasi E. Exploring the Potential Link between PFAS Exposure and Endometrial Cancer: A Review of Environmental and Sociodemographic Factors. Cancers (Basel) 2024; 16:983. [PMID: 38473344 DOI: 10.3390/cancers16050983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/01/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
This exploratory narrative review paper delves into the intricate interplay between per- and polyfluoroalkyl substances (PFAS) exposure, sociodemographic factors, and the influence of stressors in the context of endometrial cancer. PFAS, ubiquitous environmental contaminants notorious for their persistence in the ecosystem, have garnered attention for their potential to disrupt endocrine systems and provoke immune responses. We comprehensively examine the various sources of PFAS exposure, encompassing household items, water, air, and soil, thus shedding light on the multifaceted routes through which individuals encounter these compounds. Furthermore, we explore the influence of sociodemographic factors, such as income, education, occupation, ethnicity/race, and geographical location and their relationship to endometrial cancer risk. We also investigated the role of stress on PFAS exposure and endometrial cancer risk. The results revealed a significant impact of sociodemographic factors on both PFAS levels and endometrial cancer risk. Stress emerged as a notable contributing factor influencing PFAS exposure and the development of endometrial cancer, further emphasizing the importance of stress management practices for overall well-being. By synthesizing evidence from diverse fields, this review underscores the need for interdisciplinary research and targeted interventions to comprehensively address the complex relationship between PFAS, sociodemographic factors, stressors, and endometrial cancer.
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Affiliation(s)
- Aderonke Ayodele
- Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA
- Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA
| | - Emmanuel Obeng-Gyasi
- Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA
- Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA
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Hicks ML, Hicks MM, Mathews RP, Khabele D, Clare CA, Balogun O, Lawson YR, Tillman RH, Butler R, Spann CO, Parham GP. Racial disparities in endometrial cancer: Where are we after 26 years? Gynecol Oncol 2024; 184:236-242. [PMID: 38382150 DOI: 10.1016/j.ygyno.2024.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Endometrial cancer is the most commonly diagnosed female genital tract malignancy in the United States of America. Racial disparities surrounding this particular disease have been extensively investigated for over 26-years. We sought to determine if research in this area has led to any significant improvements in this disparity. METHODS We performed a rapid systematic review of English language publications on racial disparities in endometrial cancer among African American (AAW) and white American women (WAW), from 1997 to 2023. We looked at trends in incidence and survival; impact of known poor prognostic factors (stage at diagnosis, histological subtypes, grade); co-morbidities; differences in treatment (surgery, radiation and chemotherapy); socioeconomic factors; differences in biological and genetic markers; and policies/declarations. RESULTS During the period under review (1997-2023), there was a notable increase in both disease incidence (39%) and mortality (26%) rates for AAW, in comparison to WAW among whom the incidence rates increased by 2% and mortality rates rose, but 9% less than for AAW. It should be noted that the current incidence rate of 29.4% in AAW represent a reversal of what is was 26-years ago, when the incidence rate was 17.8%. In comparison to WAW, AAW had a higher prevalence of poor prognostic variables, more co-morbidities, lower income levels, less insurance coverage, and were more frequently under treated with surgery, chemotherapy and radiation. To date no actionable molecular/genetic markers have been identified. We were unable to locate any published recommendations or active programs of implementation strategies/policies designed to effectively mitigate the documented racial disparity. CONCLUSION Racial disparities in disease incidence and mortality in endometrial cancer rates between WAW and AAW have widened during a 26-year period of robust research, suggesting that current research alone is not enough to eliminate this disparity. Based on this rapid systematic review we have identified and analyzed the impact of causation variables on this disparity. Additionally, we have made strong and pertinent recommendations for the benefit of mitigating this escalating racial disparity.
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Affiliation(s)
- Michael L Hicks
- St. Joseph Mercy Oakland Cancer Center, Michigan Cancer Institute, 44405 Woodward Ave, Suite 202, Pontiac, MI 48324, USA; University of North Carolina at Chapel Hill, Department of Obstetrics & Gynecology, Chapel Hill, 101 Manning Dr. Chapel Hill, NC 27514, USA.
| | - Maya M Hicks
- Anne Arundel Medical Center, Department of Obstetrics and Gynecology, 2000 Medical Pkwy, Belcher Pavilion, Ste 309, Annapolis, MD 21401, USA
| | - Roland P Mathews
- Morehouse School of Medicine, Department of Obstetrics and Gynecology, 720 Westview Drive, Atlanta, GA 30310, USA
| | - Dineo Khabele
- Washington University, School of Medicine Department of Obstetrics and Gynecology, 660 S. Euclid Ave, Mailstop 86064-37-1005, Saint Louis, MO 63110, USA.
| | - Camille A Clare
- SUNY Downstate Health Science University, Department of Obstetric and Gynecology, 450 Clarkson Ave, MSC-24, Brooklyn, NY 11203, USA.
| | - Onyinye Balogun
- Weill Cornell Medicine, Radiation Oncology, 525 East Street, Stich Radiation Center, New York, NY 10065, USA
| | - Yolanda R Lawson
- Made Well Obstetrics and Gynecology, 2509 Thomas Ave, Dallas, TX 75201, USA
| | - Ronda Henry Tillman
- University of Arkansas Medical Center, Winthrop P. Rockerfeller Cancer Institute, 449 Jack Stephens Drive, Little Rock, AR 72205, USA
| | - Raleigh Butler
- Princess Margaret Hospital, Department of Obstetrics and Gynaecology, 102 Thompson Blvd Nassau, Bahamas
| | - Cyril O Spann
- Piedmont Hospital, 1800 Howell Mill Road Northwest, suite 300, Atlanta, GA 30318, USA
| | - Groesbeck P Parham
- Charles Drew University of Medicine and Science, Department of Obstetrics and Gynecology, 1731 E 120th St., Los Angeles, CA 90059, USA
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Anakwenze CP, Ewongwo A, Onyewadume L, Oyekan A, Chigbo CO, Valle L, Geng Y, Olapade P, Okwunze K, Lasebikan N, Jhingran A, Balogun OD, Ntekim A. A systematic review of endometrial cancer clinical research in Africa. Infect Agent Cancer 2024; 19:2. [PMID: 38217018 PMCID: PMC10787484 DOI: 10.1186/s13027-023-00563-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Women in Africa are experiencing a rising burden of endometrial cancer. Research and investment to improve treatment and outcomes are critically needed. We systematically reviewed and characterized endometrial cancer-related research within a clinically relevant context to help organize and assess existing endometrial cancer research in Africa. METHODS According to PRISMA guidelines, we searched online databases for published endometrial cancer articles from African countries from January 1, 2011, to July 20, 2021. Based on our inclusion and exclusion criteria, independent reviewers documented the study design, country/region, human development index, focus of research, type of interventions performed, and histologic and molecular type to illustrate the breadth of research coverage in each region. RESULTS A total of 18 research articles were included. With an average Human Development Index (HDI) in Africa of 0.536, the average HDI of the represented countries in this study was 0.709. The majority (88.9%) of prospective endometrial cancer research articles in Africa were from North Africa, with Egypt encompassing 83.3% of the papers. Most of these studies focused on endometrial cancer diagnosis. Research on the treatment of endometrial cancer is still emerging (33% of papers). Of all included articles, only 11.1% represented Sub-Saharan Africa, where the majority population of black Africans reside. CONCLUSIONS Endometrial cancer research in Africa is extremely limited, with the majority being concentrated in African countries with higher HDIs. As the incidence of endometrial cancer rises in Sub-Saharan Africa, there is a pressing need for more prospective clinical research to tackle the growing disease burden and improve outcomes.
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Affiliation(s)
| | - Agnes Ewongwo
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | | | - Ademola Oyekan
- Department of Radiation and Clinical Oncology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Chinelo Onwualu Chigbo
- Department of Radiation and Clinical Oncology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Luca Valle
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Yimin Geng
- Research Medical Library, MD Anderson Cancer Center, Houston, TX, USA
| | - Paul Olapade
- College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | | | - Nwamaka Lasebikan
- Department of Radiation and Clinical Oncology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Anuja Jhingran
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Onyinye D Balogun
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Atara Ntekim
- Department of Radiation Oncology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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Olatunde OA, Samaila MO, Imam MI, Uchime KE, Dauda SE. Histopathological patterns of endometrial carcinoma in a tertiary hospital in North-West Nigeria. Ecancermedicalscience 2024; 18:1651. [PMID: 38425759 PMCID: PMC10901633 DOI: 10.3332/ecancer.2024.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Indexed: 03/02/2024] Open
Abstract
Background There are relatively few studies in Nigeria, and indeed, sub-Saharan Africa that have documented the relative frequencies and histomorphological patterns of endometrial carcinoma. This study aimed to determine the relative frequencies and clinic-epidemiological characteristics of endometrial carcinoma and its histological variants in Kano, North-Western, Nigeria. Method A 10-year retrospective study of all endometrial carcinoma cases in the Department of Pathology, Aminu Kano Teaching Hospital, Kano. All relevant information was retrieved and data was analysed using Statistical Package for Social Sciences version 22. Results Endometrial carcinoma showed an increment in prevalence from 0.5% of all gynaecologic admission in 2008 to 1.0% in 2017. Type I endometrial carcinoma, specifically endometrioid adenocarcinoma accounted for 80% of cases, while endometrial serous carcinoma was the most common type II endometrial carcinoma representing 20% of cases. Over 75% of endometrial carcinomas occurred in postmenopausal women with a mean age of 59 years. Conclusion There is a rise in the prevalence of endometrial carcinoma and endometrioid adenocarcinoma is the most common histologic type.
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Affiliation(s)
- Olaniyi A Olatunde
- Department of Anatomic Pathology and Forensic Medicine, Faculty of Basic Clinical Sciences, College of Medicine, Afe Babalola University, Ado-Ekiti 360231, Ekiti State, Nigeria
- Department of Pathology, Aminu Kano Teaching Hospital, Kano 700233, Kano State, Nigeria
| | - Modupeola O Samaila
- Department of Pathology, Ahmadu Bello University Teaching Hospital, SHIKA, Zaria 810107, Kaduna State, Nigeria
| | - Mohammed I Imam
- Department of Pathology, Aminu Kano Teaching Hospital, Kano 700233, Kano State, Nigeria
| | - Kasiemobi E Uchime
- Department of Anatomic Pathology and Forensic Medicine, Faculty of Basic Clinical Sciences, College of Medicine, Afe Babalola University, Ado-Ekiti 360231, Ekiti State, Nigeria
| | - Suleiman E Dauda
- Department of Histopathology, College of Medical Sciences, Abubakar Tafawa Balewa University, Bauchi 740272, Nigeria
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Zheng S, Donnelly ED, Strauss JB. Race, Prevalence of POLE and POLD1 Alterations, and Survival Among Patients With Endometrial Cancer. JAMA Netw Open 2024; 7:e2351906. [PMID: 38231514 PMCID: PMC10794941 DOI: 10.1001/jamanetworkopen.2023.51906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024] Open
Abstract
Importance Black patients with endometrial cancer (EC) in the United States have higher mortality than patients of other races with EC. The prevalence of POLE and POLD1 pathogenic alterations in patients of different races with EC are not well studied. Objective To explore the prevalence of and outcomes associated with POLE and POLD1 alterations in differential racial groups. Design, Setting, and Participants This retrospective cohort study incorporated the largest available data set of patients with EC, including American Association for Cancer Research Project GENIE (Genomics Evidence Neoplasia Information Exchange; 5087 participants), Memorial Sloan Kettering-Metastatic Events and Tropisms (1315 participants), and the Cancer Genome Atlas Uterine Corpus Endometrial Carcinoma (517 participants), collected from 2015 to 2023, 2013 to 2021, and 2006 to 2012, respectively. The prevalence of and outcomes associated with POLE or POLD1 alterations in EC were evaluated across self-reported racial groups. Exposure Patients of different racial groups with EC and with or without POLE or POLD1 alterations. Main Outcomes and Measures The main outcome was overall survival. Data on demographic characteristics, POLE and POLD1 alteration status, histologic subtype, tumor mutation burden, fraction of genome altered, and microsatellite instability score were collected. Results A total of 6919 EC cases were studied, of whom 444 (6.4%), 694 (10.0%), and 4869 (70.4%) patients were self-described as Asian, Black, and White, respectively. Within these large data sets, Black patients with EC exhibited a lower weighted average prevalence of pathogenic POLE alterations (0.5% [3 of 590 cases]) compared with Asian (6.1% [26 of 424]) or White (4.6% [204 of 4520]) patients. By contrast, the prevalence of POLD1 pathogenic alterations was 5.0% (21 cases), 3.2% (19 cases), and 5.6% (255 cases) in Asian, Black, and White patients with EC, respectively. Patients with POLD1 alterations had better outcomes regardless of race, histology, and TP53 alteration status. For a total of 241 clinically annotated Black patients with EC, a composite biomarker panel of either POLD1 or POLE alterations identified 7.1% (17 patients) with positive outcomes (1 event at 70 months follow up) in the small sample of available patients. Conclusions and Relevance In this retrospective clinicopathological study of patients of different racial groups with EC, a composite biomarker panel of either POLD1 or POLE alteration could potentially guide treatment de-escalation, which is especially relevant for Black patients.
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Affiliation(s)
- Shuhua Zheng
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Eric D. Donnelly
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Jonathan B. Strauss
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
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Madabhushi A, Azarianpour-Esfahani S, Khalighi S, Aggarwal A, Viswanathan V, Fu P, Avril S. Computational Image and Molecular Analysis Reveal Unique Prognostic Features of Immune Architecture in African Versus European American Women with Endometrial Cancer. Res Sq 2023:rs.3.rs-3622429. [PMID: 38234757 PMCID: PMC10793492 DOI: 10.21203/rs.3.rs-3622429/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Endometrial cancer (EC) disproportionately affects African American (AA) women in terms of progression and death. In our study, we sought to employ computerized image and bioinformatic analysis to tease out morphologic and molecular differences in EC between AA and European-American (EA) populations. We identified the differences in immune cell spatial patterns between AA and EA populations with markers of tumor biology, including histologic and molecular subtypes. The models performed best when they were trained and validated using data from the same population. Unsupervised clustering revealed a distinct association between immune cell features and known molecular subtypes of endometrial cancer that varied between AA and EA populations. Our genomic analysis revealed two distinct and novel gene sets with mutations associated with improved prognosis in AA and EA patients. Our study findings suggest the need for population-specific risk prediction models for women with endometrial cancer.
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10
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Tang LS, Zhou YW, Wang JL, Zhang GX, Xu CH, Liu JY, Qiu M. Epidemiology, site-specific characteristics and survival of carcinosarcoma: a retrospective study based on SEER database. BMJ Open 2023; 13:e077974. [PMID: 38101828 PMCID: PMC10729011 DOI: 10.1136/bmjopen-2023-077974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES Carcinosarcoma (CS) is a rare and biphasic malignancy characterised by a highly invasive biological nature and poor prognosis. This study explored the epidemiology, site-specific characteristics and survival outcome of CS. DESIGN We conducted a retrospective study in the Surveillance, Epidemiology and End Results (SEER) database (1975-2018) for primary CS. SETTING AND PARTICIPANTS SEER database includes publicly available information from regional and state cancer registries in the US centres. A total of 5042 CS patients were identified. We selected the top five anatomic CS (uterus, double adnexa, lung, bladder and breast) patients for further analysis. PRIMARY OUTCOME MEASURES Incidence was estimated by geographical region, age, sex, race, stage and primary site. Trends were calculated using joinpoint regression. The cancer-specific survival (CSS) rate and initial treatment were summarised. RESULTS Nearly 80% of CS occurred in the uterus and double adnexa, followed by lung, bladder and breast. The elderly and black population presented the highest age-adjusted rate of CS. The rates of distant metastasis in CS progressively increased from 1989 to 2018. Atlanta was the area with the highest incidence at 0.7 per 100 000. Pulmonary and bladder CS more frequently occurred in men and were diagnosed with regional stage. Distant metastasis was mostly found in ovary/fallopian tube CS. Radiotherapy was more commonly applied in uterine CS, while adnexa CS cases were more likely to receive chemotherapy. Multiple treatments were more used in breast CS. Pulmonary CS seemed to suffer worse CSS (median: 9.92 months), for which radiotherapy might not provide survival benefits (HR 0.60, 95% CI 0.42 to 0.86). Compared with the common histological types in each site, CS had the shortest survival. CONCLUSIONS CS has unique clinical features in each primary site. Substantial prognosis variances exist based on tumour locations. The aggressive course is the common feature in CS at all sites.
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Affiliation(s)
- Lian-Sha Tang
- West China Hospital of Sichuan University, Chengdu, China
| | - Yu-Wen Zhou
- Department of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
| | - Jia-Ling Wang
- West China Hospital of Sichuan University, Chengdu, China
| | - Guo-Xu Zhang
- West China Hospital of Sichuan University, Chengdu, China
| | - Chen-Hao Xu
- West China Hospital of Sichuan University, Chengdu, China
| | - Ji-Yan Liu
- Department of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
| | - Meng Qiu
- Department of Abdominal Oncology, West China Hospital of Sichuan University, Chengdu, China
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Sereda Y, Alarid-Escudero F, Bickell NA, Chang SH, Colditz GA, Hur C, Jalal H, Myers ER, Layne TM, Wang SY, Yeh JM, Trikalinos TA. Approaches to developing de novo cancer population models to examine questions about cancer and race in bladder, gastric, and endometrial cancer and multiple myeloma: the Cancer Intervention and Surveillance Modeling Network incubator program. J Natl Cancer Inst Monogr 2023; 2023:219-230. [PMID: 37947329 PMCID: PMC11009510 DOI: 10.1093/jncimonographs/lgad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND We are developing 10 de novo population-level mathematical models in 4 malignancies (multiple myeloma and bladder, gastric, and uterine cancers). Each of these sites has documented disparities in outcome that are believed to be downstream effects of systemic racism. METHODS Ten models are being independently developed as part of the Cancer Intervention and Surveillance Modeling Network incubator program. These models simulate trends in cancer incidence, early diagnosis, treatment, and mortality for the general population and are stratified by racial subgroup. Model inputs are based on large population datasets, clinical trials, and observational studies. Some core parameters are shared, and other parameters are model specific. All models are microsimulation models that use self-reported race to stratify model inputs. They can simulate the distribution of relevant risk factors (eg, smoking, obesity) and insurance status (for multiple myeloma and uterine cancer) in US birth cohorts and population. DISCUSSION The models aim to refine approaches in prevention, detection, and management of 4 cancers given uncertainties and constraints. They will help explore whether the observed racial disparities are explainable by inequities, assess the effects of existing and potential cancer prevention and control policies on health equity and disparities, and identify policies that balance efficiency and fairness in decreasing cancer mortality.
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Affiliation(s)
- Yuliia Sereda
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - Fernando Alarid-Escudero
- Department of Health Policy, School of Medicine, and Stanford Health Policy, Freeman-Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Nina A Bickell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, WA University School of Medicine, St Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, WA University School of Medicine, St Louis, MO, USA
| | - Chin Hur
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Hawre Jalal
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Tracy M Layne
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Blavatnik Family Women’s Health Research Institute and Center for Scientific Diversity, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer M Yeh
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Thomas A Trikalinos
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
- Departments of Health Services, Policy, & Practice and of Biostatistics, Brown University School of Public Health, Providence, RI, USA
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12
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Anastasio MK, Gupta A, Akinyemiju TF, Previs RA. Healthcare access dimensions and uterine cancer survival: a national cancer database study. Front Oncol 2023; 13:1263371. [PMID: 37869101 PMCID: PMC10585829 DOI: 10.3389/fonc.2023.1263371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Objective Disparities exist throughout diagnosis, treatment, and survival for Black patients with uterine cancer. There is limited data on how several healthcare access (HCA) dimensions contribute to these disparities in patients with advanced stage uterine cancer. Methods Using the National Cancer Database (NCDB), we identified patients aged 40-89 years with Stage III-IV uterine cancer between 2004-2015 who received chemotherapy and/or radiotherapy. Race/ethnicity were classified as non-Hispanic (NH)-Black, Hispanic, and NH-White. Variables defined in the NCDB were used to assess HCA affordability, availability, and accessibility. Kaplan-Meier estimates, log-rank test, and multivariable Cox proportional hazards models were used to analyze overall survival. Results Of 43,134 patients, 78.8% of the cohort identified as NH-White, 15.3% NH-Black, and 5.9% Hispanic. NH-Black patients were the most likely to have type II (75.6% vs. 53.9% and 55.4%) and stage IV (40.8% vs. 30.7% and 32.3%) disease compared to NH-White and Hispanic patients. NH-Black patients were more likely than NH-White and Hispanic patients to have government funded insurance (58.6% vs. 50.3% and 50.4%), live in low-income areas (46.4% vs. 14.2% and 29.9%), and receive only chemotherapy (53.5% vs. 43.1% and 46.2%). Having private insurance and receiving treatment at an academic facility were positive predictors of survival. NH-Black patients had worse survival than NH-White patients after adjusting for clinical characteristics and healthcare access dimensions (HR 1.29; 95% CI 1.24, 1.34). Conclusion While HCA affordability and availability predicted survival in patients with advanced stage uterine cancer, additional factors contribute to racial disparities. Compared to NH-White patients, NH-Black patients had more aggressive disease, received only chemotherapy rather than combined therapy, and had worse survival regardless of cancer subtype. Additional dimensions of healthcare access must be explored to remedy uterine cancer disparities.
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Affiliation(s)
- Mary Katherine Anastasio
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States
| | - Anjali Gupta
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Stanford University School of Medicine, Stanford, CA, United States
| | - Tomi F. Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Rebecca A. Previs
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States
- Division of Gynecologic Oncology, Duke Cancer Institute, Durham, NC, United States
- Labcorp Oncology, Durham, NC, United States
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Somasegar S, Bashi A, Lang SM, Liao CI, Johnson C, Darcy KM, Tian C, Kapp DS, Chan JK. Trends in Uterine Cancer Mortality in the United States: A 50-Year Population-Based Analysis. Obstet Gynecol 2023; 142:978-986. [PMID: 37678887 PMCID: PMC10510793 DOI: 10.1097/aog.0000000000005321] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To analyze mortality trends in uterine cancer in the United States over 50 years with an emphasis on age and race and ethnicity. METHODS Data on uterine cancer deaths from 1969 to 2018 were obtained from the National Center for Health Statistics. Trends were examined by age and race and ethnicity after adjustment for the hysterectomy rate and pregnancy. RESULTS Uterine cancer mortality decreased between 1969 and 1997 (from 6.03 to 4.00/100,000) but increased between 1997 and 2018 (from 4.00 to 5.02/100,000). From 2001 to 2018, mortality rates increased by 1.25-fold across all age groups. In 2018, the mortality rate from uterine cancer for patients aged 70 years or older and 60-69 years was sixfold and threefold higher, respectively, than in younger patients (aged 50-59 years) (54.87/100,000 vs 27.80/100,000 vs 8.70/100,000). The mortality rate for non-Hispanic Black women was 2.2-fold higher than for non-Hispanic White, Hispanic, and non-Hispanic Asian or Pacific Islander women (17.6/100,000 vs 7.82/100,000, 6.54/100,000, and 4.24/100,000, respectively). On an intersection analysis of age and race, non-Hispanic Black women aged older than 60 years had a threefold higher mortality rate than non-Hispanic White women (72/100,000 vs 24/100,000). A notable finding was that young non-Hispanic Black and Hispanic women (30-39 years) had the highest annual increases in mortality at 3.3% and 3.8% per year compared with 2.2% in non-Hispanic White women. CONCLUSION Since 2001, the uterine cancer mortality rate has increased across all four racial and ethnic groups examined, with the highest increase seen among non-Hispanic Black women. The largest increase in mortality was observed among younger non-Hispanic Black and Hispanic women.
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Affiliation(s)
- Sahana Somasegar
- Division of Gynecologic Oncology and the Department of Radiation Oncology, Stanford University School of Medicine, and the Division of Gynecologic Oncology, California Pacific/Palo Alto/Sutter Health Research Institute, Palo Alto, California; the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; the Department of Obstetrics & Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; the California Pacific Medical Center Research Institute, San Francisco, California; and the Gynecologic Cancer Center of Excellence Program, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, and the Henry M. Jackson Foundation for Advancement of Military Medicine, Inc., Bethesda, Maryland
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Xu X, Chen L, Nunez-Smith M, Clark M, Wright JD. Timeliness of diagnostic evaluation for postmenopausal bleeding: A retrospective cohort study using claims data. PLoS One 2023; 18:e0289692. [PMID: 37682914 PMCID: PMC10490884 DOI: 10.1371/journal.pone.0289692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Postmenopausal bleeding (PMB) is a common gynecologic condition. Although it can be a sign of uterine cancer, most patients have benign etiology. However, research on quality of diagnostic evaluation for PMB has been limited to cancer patients. To extend this research, we examined the timeliness of diagnostic evaluation for PMB among patients with benign conditions. METHODS Using the 2008-2019 MarketScan Research Databases, we identified 499176 patients (456741 with commercial insurance and 42435 with Medicaid insurance) who presented with PMB but did not have gynecologic cancer. For each patient, we measured the time from their PMB reporting to the date of their first diagnostic procedure. The association between patient characteristics and time to first diagnostic procedure was examined using Cox proportional hazards models (for the overall sample and then stratified by insurance type). RESULTS Overall, 54.3% of patients received a diagnostic procedure on the same day when they reported PMB and 86.6% received a diagnostic procedure within 12 months after reporting PMB. These percentages were 39.4% and 77.1%, respectively, for Medicaid patients, compared to 55.7% and 87.4%, respectively, for commercially insured patients (p<0.001 for both). Medicaid patients had an 18% lower rate of receiving a diagnostic procedure at any given time point than commercially insured patients (adjusted hazard ratio = 0.82, 95% CI: 0.81-0.83). Meanwhile, older age and non-gynecologic comorbidities were associated with a lower rate whereas concomitant gynecologic conditions and recent use of preventive care were associated with a higher rate of receiving diagnostic procedures. Analysis stratified by insurance type identified additional risk factors for delayed diagnostic procedures (e.g., non-metropolitan versus metropolitan location for commercially insured patients and Black versus White race for Medicaid patients). CONCLUSION A sizable proportion of patients did not receive prompt diagnostic evaluation for PMB. Both clinical and non-clinical factors could affect timeliness of evaluation.
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Affiliation(s)
- Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Ling Chen
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America
| | - Marcella Nunez-Smith
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Mitchell Clark
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Jason D. Wright
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America
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Medina HN, Penedo FJ, Joachim C, Deloumeaux J, Koru-Sengul T, Macni J, Bhakkan B, Peruvien J, Schlumbrecht MP, Pinheiro PS. Endometrial cancer risk and trends among distinct African descent populations. Cancer 2023; 129:2717-2726. [PMID: 37357566 DOI: 10.1002/cncr.34789] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Endometrial cancer (EC) is the fourth most common cancer among Black women in the United States, a population disproportionately affected by aggressive nonendometrioid subtypes (e.g., serous, carcinosarcoma). To examine EC vulnerability among a wider spectrum of African descent populations, a comparison between Black women residing in different countries, rather than in the United States alone, is needed. METHODS The authors analyzed 34,789 EC cases from Florida (FL) (2005-2018), Martinique (2005-2018), and Guadeloupe (2008-2018) based on cancer registry data. Age-adjusted incidence rates, incidence rate ratios (IRRs), and annual percent changes (APC) in trends were estimated for Black populations residing in the United States (non-Hispanic Blacks [NHB]) and Caribbean. The US non-Hispanic White (NHW) population was used as a reference. RESULTS Caribbean Black women had the lowest rates for endometrioid and nonendometrioid subtypes. Nonendometrioid types were most common among US (FL) NHBs (9.2 per 100,000), 2.6 times greater than NHWs (IRR, 2.60; 95% confidence interval [CI], 2.44-2.76). For endometrioid EC, rates increased 1.8% (95% CI, 0.1-3.5) yearly from 2005 to 2018 for US (FL) NHBs and 1.2% (95% CI, 0.9-1.6) for US (FL) NHWs whereas no change was observed for Caribbean Blacks. For nonendometroid carcinomas, rates increased 5.6% (95% CI, 4.0-7.2) among US (FL) NHB, 4.4% (95% CI, 0.3-8.6) for Caribbean Black, and 3.9% for US (FL) NHW women (95% CI, 2.4-5.5). CONCLUSIONS Lower rates of nonendometrioid EC among Caribbean Black women suggest that vulnerability for these aggressive tumor subtypes may not currently be an overarching African ancestry disparity. Most importantly, there is an alarmingly increasing trend in nonendometrioid across all populations studied, which warrants further surveillance and etiological research for this particular subtype. PLAIN LANGUAGE SUMMARY We analyze population-based incidence rates and trends of endometrial cancer (EC) for African descent populations residing in different countries (i.e., United States, Martinique, Guadeloupe) to examine whether EC vulnerability among Black women is socio-environmental or more ancestry-specific in nature. The increased EC risk was not uniform across all Black women since the Caribbean had the lowest rates (for endometrioid and nonendometrioid histology subtypes). Regardless, from 2005 to 2018, there was an increasing trajectory of nonendometrioid EC for all groups, regardless of race.
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Affiliation(s)
- Heidy N Medina
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA
| | - Frank J Penedo
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
- Department of Psychology, University of Miami, Miami, Florida, USA
| | - Clarisse Joachim
- Martinique Cancer Registry, University Hospital of Martinique, Martinique, France
| | | | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
| | - Jonathan Macni
- Martinique Cancer Registry, University Hospital of Martinique, Martinique, France
| | - Bernard Bhakkan
- Guadeloupe Cancer Registry, University Hospital of Guadeloupe, Guadeloupe, France
| | - Jessica Peruvien
- Guadeloupe Cancer Registry, University Hospital of Guadeloupe, Guadeloupe, France
| | - Matthew P Schlumbrecht
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
- Department of Obstetrics & Gynecology, University of Miami School of Medicine, Miami, Florida, USA
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
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Saini A, Suh L, Gao J, Leung K, Wilkie G, Matteson K, Korets S. Intra-operative tumor spillage in minimally invasive surgery for endometrial cancer and its impact on recurrence risk. Gynecol Oncol 2023; 175:128-132. [PMID: 37356313 DOI: 10.1016/j.ygyno.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE The prognostic impact of intra-operative tumor spillage (ITS) during minimally invasive surgery (MIS) for endometrial cancer (EC) is not well studied. The objective of this study was to determine if there is an association between ITS and EC recurrence. METHODS We performed a case-control study of patients with a laparoscopic or robot-assisted hysterectomy with EC on final pathology between 2017 and 2022 and compared those with (case) and without (control) a subsequent EC recurrence. Electronic medical records were reviewed for demographic, intra-operative and pathologic details, and recurrence status. ITS was defined as uterine perforation with a manipulator, presence of extra-uterine tumor after colpotomy or specimen delivery, exposure of uncontained specimen into peritoneum, and/or pathology/operative reports noting specimen fragmentation. Conditional logistic regression was used to determine odds ratios for the association of cancer recurrence with ITS. We adjusted for >50% myoinvasion, tumor size, and adjuvant treatment. RESULTS 1057 patients underwent MIS for EC. Approximately 8% (n = 86) developed recurrent cancer and 172 patients were selected as controls. Twenty percent of recurrent cases (17/86) had ITS compared with 4% of nonrecurrent controls (7/172). When adjusted for tumor size, deep myoinvasion, and adjuvant treatment, patients with ITS had a 5.6 times increased odds (aOR 5.63, 95% CI 1.52-20.86) of recurrence compared to patients without ITS. CONCLUSIONS In patients with EC, we found an association between ITS and cancer recurrence. These findings warrant further investigation to determine if adjuvant therapy or surgical technique should be altered to improve outcomes.
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Affiliation(s)
- Aashna Saini
- Department of Obstetrics & Gynecology, University of Massachusetts Memorial Medical Center, Worcester, MA 01605, USA; University of Massachusetts T.H. Chan Medical School, Worcester, MA 01655, USA.
| | - Lyle Suh
- University of Massachusetts T.H. Chan Medical School, Worcester, MA 01655, USA
| | - Jenny Gao
- University of Massachusetts T.H. Chan Medical School, Worcester, MA 01655, USA
| | - Katherine Leung
- University of Massachusetts T.H. Chan Medical School, Worcester, MA 01655, USA
| | - Gianna Wilkie
- Department of Obstetrics & Gynecology, University of Massachusetts Memorial Medical Center, Worcester, MA 01605, USA; University of Massachusetts T.H. Chan Medical School, Worcester, MA 01655, USA
| | - Kristen Matteson
- Department of Obstetrics & Gynecology, University of Massachusetts Memorial Medical Center, Worcester, MA 01605, USA; University of Massachusetts T.H. Chan Medical School, Worcester, MA 01655, USA
| | - Sharmilee Korets
- Department of Obstetrics & Gynecology, University of Massachusetts Memorial Medical Center, Worcester, MA 01605, USA; University of Massachusetts T.H. Chan Medical School, Worcester, MA 01655, USA
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Xu X, Chen L, Nunez-Smith M, Clark M, Wright JD. Racial disparities in diagnostic evaluation of uterine cancer among Medicaid beneficiaries. J Natl Cancer Inst 2023; 115:636-643. [PMID: 36788453 PMCID: PMC10248843 DOI: 10.1093/jnci/djad027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/22/2023] [Accepted: 01/28/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND To inform reasons contributing to Black-White disparity in early diagnosis of uterine cancer, we compared the quality of diagnostic evaluation received by Black vs White patients with abnormal uterine bleeding (AUB) ultimately diagnosed with uterine cancer. METHODS Using 2008-2019 MarketScan Multi-State Medicaid Database, we identified Black (n = 858) and White (n = 1749) patients with uterine cancer presenting with AUB. Quality of diagnostic evaluation was measured by delayed diagnosis (>1 year after AUB reporting), not receiving guideline-recommended diagnostic procedures, delayed time to first diagnostic procedure (>2 months after AUB reporting), number of diagnostic procedures received, and number of evaluation and management visits for AUB. The association between race and quality indicators was examined by multivariable regressions adjusting for patient characteristics. RESULTS Black patients were more likely than White patients to experience delayed diagnosis (11.3% vs 8.3%, P = .01; adjusted odds ratio [OR] = 1.71, 95% confidence interval [CI] = 1.27 to 2.29) or to not receive guideline-recommended diagnostic procedures (10.1% vs 5.0%, P < .001; adjusted OR = 1.94, 95% CI = 1.40 to 2.68). Even when they did receive recommended diagnostic procedures, Black patients were more likely than White patients to experience delay in time to the first diagnostic procedure (adjusted OR = 1.46, 95% CI = 1.09 to 1.97). In addition, Black patients underwent more evaluation and management visits for AUB before getting diagnosed compared with White patients (adjusted mean ratio = 1.13, 95% CI = 1.04 to 1.23). CONCLUSIONS Black and White patients with uterine cancer differed in the quality of diagnostic evaluation received. Improving equity in this area may help reduce Black-White disparity in stage at diagnosis.
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Affiliation(s)
- Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - Ling Chen
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - Mitchell Clark
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Liu X, Jin S, Zi D. Overall survival prediction models for gynecological endometrioid adenocarcinoma with squamous differentiation (GE-ASqD) using machine-learning algorithms. Sci Rep 2023; 13:8395. [PMID: 37225749 DOI: 10.1038/s41598-023-33748-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/18/2023] [Indexed: 05/26/2023] Open
Abstract
The actual 5-year survival rates for Gynecological Endometrioid Adenocarcinoma with Squamous Differentiation (GE-ASqD) are rarely reported. The purpose of this study was to evaluate how histological subtypes affected long-term survivors of GE-ASqD (> 5 years). We conducted a retrospective analysis of patients diagnosed GE-ASqD from the Surveillance, Epidemiology, and End Results database (2004-2015). In order to conduct the studies, we employed the chi-square test, univariate cox regression, and multivariate cox proportional hazards model. A total of 1131 patients with GE-ASqD were included in the survival study from 2004 to 2015 after applying the inclusion and exclusion criteria and the sample randomly split into a training set and a test set at a ratio of 7:3. Five machine learning algorithms were trained based on nine clinical variables to predict the 5-year overall survival. The AUC of the training group for the LR, Decision Tree, forest, Gbdt, and gbm algorithms were 0.809, 0.336, 0.841, 0.823, and 0.856 respectively. The AUC of the testing group was 0.779, 0.738, 0.753, 0.767 and 0.734, respectively. The calibration curves confirmed good performance of the five machine learning algorithms. Finally, five algorithms were combined to create a machine learning model that forecasts the 5-year overall survival rate of patients with GE-ASqD.
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Affiliation(s)
- Xiangmei Liu
- Guizhou Medical University, Guiyang, China
- Department of Gynecology and Obstetrics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Shuai Jin
- School of Big Health, Guizhou Medical University, Guiyang, China
| | - Dan Zi
- Department of Gynecology and Obstetrics, Guizhou Provincial People's Hospital, Guiyang, China.
- Department of Gynecology and Obstetrics, The Affiliated People's Hospital of Guizhou Medical University, Guiyang, China.
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Mawson AR. Understanding health disparities affecting people of West Central African descent in the United States: An evolutionary perspective. Evol Appl 2023; 16:963-978. [PMID: 37216026 PMCID: PMC10197229 DOI: 10.1111/eva.13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/19/2023] [Accepted: 04/02/2023] [Indexed: 05/24/2023] Open
Abstract
Human populations adapting to diverse aspects of their environment such as climate and pathogens leave signatures of genetic variation. This principle may apply to people of West Central African descent in the United States, who are at increased risk of certain chronic conditions and diseases compared to their European counterparts. Less well known is that they are also at reduced risk of other diseases. While discriminatory practices in the United States continue to affect access to and the quality of healthcare, the health disparities affecting African Americans may also be due in part to evolutionary adaptations to the original environment of sub-Saharan Africa, which involved continuous exposure to the vectors of potentially lethal endemic tropical diseases. Evidence is presented that these organisms selectively absorb vitamin A from the host, and its use in parasite reproduction contributes to the signs and symptoms of the respective diseases. These evolutionary adaptations included (1) sequestering vitamin A away from the liver to other organs, to reduce accessibility to the invaders; and (2) reducing the metabolism and catabolism of vitamin A (vA), causing it to accumulate to subtoxic concentrations and weaken the organisms, thereby reducing the risk of severe disease. However, in the environment of North America, lacking vA-absorbing parasites and with a mainly dairy-based diet that is high in vA, this combination of factors is hypothesized to lead to the accumulation of vA and to increased sensitivity to vA as a toxin, which contribute to the health disparities affecting African Americans. vA toxicity is linked to numerous acute and chronic conditions via mitochondrial dysfunction and apoptosis. Subject to testing, the hypothesis suggests that the adoption of traditional or modified West Central African-style diets that are low in vA and high in vA-absorbing fiber hold promise for disease prevention and treatment, and as a population-based strategy for health maintenance and longevity.
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Affiliation(s)
- Anthony R. Mawson
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health SciencesJackson State UniversityJacksonMississippiUSA
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Kucera CW, Tian C, Tarney CM, Presti C, Jokajtys S, Winkler SS, Casablanca Y, Bateman NW, Mhawech-Fauceglia P, Wenzel L, Hamilton CA, Chan JK, Jones NL, Rocconi RP, O’Connor TD, Farley JH, Shriver CD, Conrads TP, Phippen NT, Maxwell GL, Darcy KM. Factors Associated With Survival Disparities Between Non-Hispanic Black and White Patients With Uterine Cancer. JAMA Netw Open 2023; 6:e238437. [PMID: 37067801 PMCID: PMC10111180 DOI: 10.1001/jamanetworkopen.2023.8437] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/02/2023] [Indexed: 04/18/2023] Open
Abstract
Importance Disparities in survival exist between non-Hispanic Black (hereafter, Black) and non-Hispanic White (hereafter, White) patients with uterine cancer. Objective To investigate factors associated with racial disparities in survival between Black and White patients with uterine cancer. Design, Setting, and Patients This cohort study used data from the National Cancer Database on 274 838 Black and White patients who received a diagnosis of uterine cancer from January 1, 2004, to December 31, 2017, with follow-up through December 2020. Statistical analysis was performed in July 2022. Main Outcomes and Measures Overall survival by self-reported race and evaluation of explanatory study factors associated with hazard ratio (HR) reduction for Black vs White patients. A propensity scoring approach was applied sequentially to balance racial differences in demographic characteristics, comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, and treatment. Results The study included 32 230 Black female patients (mean [SD] age at diagnosis, 63.8 [10.0] years) and 242 608 White female patients (mean [SD] age at diagnosis, 63.5 [10.5] years) and had a median follow-up of 74.0 months (range, 43.5-113.8 months). Black patients were more likely than White patients to have low income (44.1% vs 14.0%), be uninsured (5.7% vs 2.6%), present with nonendometrioid histologic characteristics (46.1% vs 21.6%), have an advanced disease stage (34.1% vs 19.8%), receive first-line chemotherapy (33.8% vs 18.2%), and have worse 5-year survival (58.6% vs 78.5%). Among patients who received a diagnosis at younger than 65 years of age, the HR for death for Black vs White patients was 2.43 (95% CI, 2.34-2.52) in a baseline demographic-adjusted model and 1.29 (95% CI, 1.23-1.35) after balancing other factors. Comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, treatment, and unexplained factors accounted for 0.8%, 7.2%, 11.5%, 53.1%, 5.8%, 1.2%, and 20.4%, respectively, of the excess relative risk (ERR) among the younger Black vs White patients. Among patients 65 years or older, the HR for death for Black vs White patients was 1.87 (95% CI, 1.81-1.93) in the baseline model and 1.14 (95% CI, 1.09-1.19) after balancing other factors. Comorbidity score, neighborhood income, insurance status, histologic subtype, disease stage, treatment, and unexplained factors accounted for 3.0%, 7.5%, 0.0%, 56.2%, 10.6%, 6.9%, and 15.8%, respectively, of the ERR among Black vs White patients aged 65 years or older. Conclusions and Relevance This study suggests that histologic subtype was the dominant factor associated with racial survival disparity among patients with uterine cancer, while insurance status represented the main modifiable factor for women younger than 65 years. Additional studies of interactions between biology and social determinants of health are merited.
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Affiliation(s)
- Calen W. Kucera
- 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, Maryland
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Chunqiao Tian
- 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, Maryland
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Christopher M. Tarney
- 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, Maryland
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Cassandra Presti
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia
| | - Suzanne Jokajtys
- 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, Maryland
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Stuart S. Winkler
- 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, Maryland
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Yovanni Casablanca
- 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, Maryland
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Nicholas W. Bateman
- 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, Maryland
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Paulette Mhawech-Fauceglia
- 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, Maryland
- Aurora Diagnostics, LMC Pathology Services, Las Vegas, Nevada
| | - Lari Wenzel
- Department of Medicine, School of Medicine, University of California, Irvine
- Department of Public Health, School of Medicine, University of California, Irvine
| | - Chad A. Hamilton
- Gynecologic Oncology Section, Women’s Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, Louisiana
| | - John K. Chan
- Gynecologic Oncology Division, Palo Alto Medical Foundation/California Pacific Medical Center/Sutter Health, San Francisco
| | - Nathaniel L. Jones
- Division of Gynecologic Oncology, the Mitchell Cancer Institute, University of South Alabama, Mobile
| | - Rodney P. Rocconi
- Division of Gynecologic Oncology, the University of Alabama at Birmingham, Infirmary Cancer Care, Infirmary Health, Mobile
| | - Timothy D. O’Connor
- Institute for Genome Sciences, Department of Medicine, Program in Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore
- Program in Health Equity and Population Health, University of Maryland School of Medicine, Baltimore
- The University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore
| | - John H. Farley
- Division of Gynecologic Oncology, Dignity Health Cancer Institute, Dignity Health St Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Craig D. Shriver
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Thomas P. Conrads
- 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, Maryland
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland
- Women’s Health Integrated Research Center, Inova Women’s Service Line, Inova Health System, Falls Church, Virginia
| | - Neil T. Phippen
- 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, Maryland
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - G. Larry Maxwell
- 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, Maryland
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland
- Women’s Health Integrated Research Center, Inova Women’s Service Line, Inova Health System, Falls Church, Virginia
| | - Kathleen M. Darcy
- 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, Maryland
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
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21
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Abstract
Ovarian, uterine, and vulvovaginal cancers affect approximately 96,000 women per year in the United States, resulting in approximately 29,000 deaths annually. Routine screening protocols do not detect these malignancies; thus, the recognition of risk factors and evaluation of worrisome symptoms are essential for early detection and improved prognoses. Treatment is managed by gynecologic oncologists, and often involves a combination of surgery, chemotherapy, and possible radiation treatments. Survivor care is managed by the primary-care clinician: expert attention to the mental, physical, and sexual health of each patient will ensure the best outcomes and quality of life.
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Affiliation(s)
- Deborah Gomez Kwolek
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Stefanie Gerstberger
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Sarah Tait
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Jeanna M Qiu
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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22
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Orellana TJ, Garrett AA, Soong TR, Rives T, Courtney-Brooks M, Taylor SE, Lesnock J, Berger J, Boisen M, Coffman L, Buckanovich R, Mahdi H, Comerci JC, Beriwal S, Sukumvanich P, Edwards RP, Bhargava R, Olawaiye AB. The role of adjuvant treatment for early-stage uterine clear cell carcinomas. Gynecol Oncol 2023; 170:77-83. [PMID: 36641903 DOI: 10.1016/j.ygyno.2022.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Uterine clear cell carcinoma is a rare and aggressive subtype of endometrial carcinoma. Prospective clinical trials have not been feasible for this rare tumor, and data regarding the optimal adjuvant treatment regimen for early-stage uterine clear cell carcinomas is limited. Our study's objective was to determine if adjuvant chemotherapy or radiation therapy improves patients' outcomes in stage I and II uterine clear cell carcinoma. METHODS Patients with stage I and II uterine clear cell carcinoma were identified at a single institution. All cases were reviewed by a gynecologic pathologist. Both pure and mixed non-serous uterine clear cell carcinomas were included. Primary outcomes were recurrence free survival and overall survival. RESULTS A total of 71 patients were identified including 39 (55%) pure and 32 (45%) mixed clear cell carcinoma. Most patients were FIGO stage IA (77.5%). Most patients (n = 58, 82%) received adjuvant therapy, including 43 (61%) receiving chemotherapy, 50 (70%) receiving radiation therapy, and 35 (49%) receiving both. Recurrence free survival was not significantly different among patients receiving no or <6 cycles of chemotherapy versus patients receiving 6 cycles of chemotherapy (p = 0.39). However, median OS was significantly different among patients receiving no or <6 cycles of chemotherapy versus 6 cycles of chemotherapy (p = 0.004). On univariable analysis, 6 cycles of chemotherapy was significantly associated with improved OS (HR 0.1, 95% CI 0.01-0.07). Presence of LVSI, mutated p53, number of pelvic and para-aortic lymph nodes assessed, adjuvant chemotherapy (any number of cycles), and >2 medical co-morbidities were not significant predictors of OS on univariable analysis. On multivariable analysis, 6 cycles of adjuvant chemotherapy remained a significant predictor of improved OS (HR 0.1, 95% CI 0.01-0.8). CONCLUSIONS In this study, administration of 6 cycles of chemotherapy appears to significantly improve OS. This finding suggests consideration of 6 cycles of adjuvant chemotherapy in patients with early-stage uterine clear cell carcinoma, however clinical trials are needed to confirm these findings.
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Affiliation(s)
- T J Orellana
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America.
| | - A A Garrett
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - T R Soong
- Department of Pathology, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - T Rives
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - M Courtney-Brooks
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - S E Taylor
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - J Lesnock
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - J Berger
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - M Boisen
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - L Coffman
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - R Buckanovich
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - H Mahdi
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - J C Comerci
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - S Beriwal
- Allegheny Health Network, Pittsburgh, PA, United States of America
| | - P Sukumvanich
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - R P Edwards
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - R Bhargava
- Department of Pathology, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
| | - A B Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, United States of America
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23
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Philp L, Alimena S, Sullivan M, Del Carmen M, Bregar A, Eisenhauer E, Goodman A, Sisodia RC. Black and hispanic women have less support during cancer evaluation and treatment: results from a prospective patient reported outcomes program in gynecologic malignancy. Int J Gynecol Cancer 2023; 33:770-777. [PMID: 36639193 DOI: 10.1136/ijgc-2022-004113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Race remains a significant predictor of poor outcomes in women with gynecologic cancer and minority patients consistently report worse quality of life during cancer treatment. Disparities between patients in strength of social and emotional supports may contribute to these outcomes. This study's objective was to describe the racial differences in patient reported outcomes of women being evaluated or treated for a gynecologic malignancy at a large tertiary cancer hospital. METHODS In this prospective cohort study, all patients presenting for care at a tertiary care gynecologic oncology clinic between January 2018 and September 2019 were evaluated for inclusion. All patients were administered validated patient reported outcome measure questionnaires at serial visits. Demographic data was gathered including self-reported race. Patients were characterized as White, Black, Asian, Hispanic/Latino, or Other. Patient reported outcomes were compared between respondents of different races using linear and logistic regression. RESULTS Between January 2018 to September 2019, 2022 patients with a known race completed questionnaires. Of these patients, 86.7% were White, 4.3% Black, and 4.9% Hispanic/Latino and 58.7% had a known cancer diagnosis. Non-White patients were significantly less likely to complete questionnaires (p<0.001). Non-White patients reported significantly lower levels of emotional support on all questions (Patient-Reported Outcomes Measurement Information System (PROMIS) emotional support: Q1 p<0.001, Q2 p<0.001, Q3 p=0.013, Q4 p=0.002), and lower overall emotional (p=0.005) and instrumental (p=0.005) support scores when compared with White patients. Hispanic/Latino patients reported the lowest levels of emotional and instrumental support and more cognitive (p=0.043) and financial (p=0.040) difficulties associated with treatment. Black women reported having less support with chores while sick (p=0.014) and being less likely to have someone to talk to (p=0.013). CONCLUSIONS Significant differences exist in patient reported outcomes between women of different racial backgrounds. Hispanic/Latino and Black women have less support during gynecologic cancer evaluation and treatment as compared with White women.
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Affiliation(s)
- Lauren Philp
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada .,Division of Gynecologic Oncology, University Health Network / Sinai Health System, Toronto, Ontario, Canada
| | - Stephanie Alimena
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mackenzie Sullivan
- Department of Obstetrics and Gynecology, Massachusetts General Hospital / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marcela Del Carmen
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy Bregar
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eric Eisenhauer
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Annekathryn Goodman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel Clark Sisodia
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
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24
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Chapman-Davis E, Webster EM, Balogun OD, Frey MK, Holcomb K. Landmark Series on Disparities: Uterine Cancer and Strategies for Mitigation. Ann Surg Oncol 2023; 30:48-57. [PMID: 36376567 DOI: 10.1245/s10434-022-12765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022]
Abstract
Longstanding racial disparities exist in uterine cancer. There is a growing body of literature documenting differences in the prevalence, diagnosis, treatment, and tumor characteristics of uterine cancer in Black women compared with White women that significantly contribute to the outcome disparity seen between the groups. This article seeks to provide an overview of racial disparities present in uterine cancer, with attention on Black women in the USA, as well as offer a review on the multifactorial etiology of the disparities described.
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Affiliation(s)
- Eloise Chapman-Davis
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA.
| | - Emily M Webster
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Onyinye D Balogun
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Melissa K Frey
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Kevin Holcomb
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
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25
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Harkenrider MM, Abu-Rustum N, Albuquerque K, Bradfield L, Bradley K, Dolinar E, Doll CM, Elshaikh M, Frick MA, Gehrig PA, Han K, Hathout L, Jones E, Klopp A, Mourtada F, Suneja G, Wright AA, Yashar C, Erickson BA. Radiation Therapy for Endometrial Cancer: An American Society for Radiation Oncology Clinical Practice Guideline. Pract Radiat Oncol 2023; 13:41-65. [PMID: 36280107 DOI: 10.1016/j.prro.2022.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE With the results of several recently published clinical trials, this guideline informs on the use of adjuvant radiation therapy (RT) and systemic therapy in the treatment of endometrial cancer. Updated evidence-based recommendations provide indications for adjuvant RT and the associated techniques, the utilization and sequencing of adjuvant systemic therapies, and the effect of surgical staging techniques and molecular tumor profiling. METHODS The American Society for Radiation Oncology convened a multidisciplinary task force to address 6 key questions that focused on the adjuvant management of patients with endometrial cancer. The key questions emphasized the (1) indications for adjuvant RT, (2) RT techniques, target volumes, dose fractionation, and treatment planning aims, (3) indications for systemic therapy, (4) sequencing of systemic therapy with RT, (5) effect of lymph node assessment on utilization of adjuvant therapy, and (6) effect of molecular tumor profiling on utilization of adjuvant therapy. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for quality of evidence grading and strength of recommendation. RESULTS The task force recommends RT (either vaginal brachytherapy or external beam RT) be given based on the patient's clinical-pathologic risk factors to reduce risk of vaginal and/or pelvic recurrence. When external beam RT is delivered, intensity modulated RT with daily image guided RT is recommended to reduce acute and late toxicity. Chemotherapy is recommended for patients with International Federation of Gynecology and Obstetrics (FIGO) stage I to II with high-risk histologies and those with FIGO stage III to IVA with any histology. When sequencing chemotherapy and RT, there is no prospective data to support an optimal sequence. Sentinel lymph node mapping is recommended over pelvic lymphadenectomy for surgical nodal staging. Data on sentinel lymph node pathologic ultrastaging status supports that patients with isolated tumor cells be treated as node negative and adjuvant therapy based on uterine risk factors and patients with micrometastases be treated as node positive. The available data on molecular characterization of endometrial cancer are compelling and should be increasingly considered when making recommendations for adjuvant therapy. CONCLUSIONS These recommendations guide evidence-based best clinical practices on the use of adjuvant therapy for endometrial cancer.
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Affiliation(s)
- Matthew M Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois.
| | - Nadeem Abu-Rustum
- Department of Gynecologic Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | - Kristin Bradley
- Department of Radiation Oncology, University of Wisconsin, Madison, Wisconsin
| | | | - Corinne M Doll
- Department of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Mohamed Elshaikh
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Melissa A Frick
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Paola A Gehrig
- Division of Gynecologic Oncology, University of Virginia, Charlottesville, Virginia
| | - Kathy Han
- Department of Radiation Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Lara Hathout
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Ellen Jones
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Ann Klopp
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Firas Mourtada
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Gita Suneja
- Department of Radiation Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
| | - Alexi A Wright
- Department of Medical Oncology, Dana-Farber Cancer Center, Boston, Massachusetts
| | - Catheryn Yashar
- Department of Radiation Oncology, University of California, San Diego, California
| | - Beth A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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26
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Karia PS, Huang Y, Tehranifar P, Wright JD, Genkinger JM. Racial and ethnic differences in type II endometrial cancer mortality outcomes: The contribution of sociodemographic, clinicopathologic, and treatment factors. Gynecol Oncol 2023; 168:119-126. [PMID: 36434946 PMCID: PMC9797437 DOI: 10.1016/j.ygyno.2022.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The burden of type II endometrial cancer (EC) is rising dramatically in the U.S. Although type II EC disproportionately affects Black women, the magnitude of racial/ethnic differences in type II EC mortality outcomes and factors underlying these differences remain understudied. We examined racial/ethnic differences in cancer-specific and overall mortality in women with type II EC and quantified the extent to which mortality differences are mediated by sociodemographic, clinicopathologic, and treatment factors. METHODS 14,710 women ≥18 years with type II EC from 2007 to 2016 were identified from the Surveillance, Epidemiology, and End Results database. The association between race/ethnicity (non-Hispanic White [NHW], non-Hispanic Black [NHB], Hispanic, and non-Hispanic Asian/Pacific Islander [NHAPI]) and cancer-specific and overall mortality was examined. Mediation analysis was used to identify factors underlying differences in mortality outcomes. RESULTS NHB women had a higher risk of cancer-specific mortality than NHW women (hazard ratio [HR]: 1.22, 95% CI: 1.12-1.33), whereas NHAPI (HR: 0.88, 95% CI: 0.78-0.99) and Hispanic women (HR: 0.91, 95% CI: 0.81-1.01) had a lower risk of cancer-specific mortality than NHW women. Differences in clinicopathologic (stage, grade, histologic subtype), sociodemographic (insurance type, geographic region and location, neighborhood socioeconomic status), and treatment factors (treatment type, lymphadenectomy) explained 43.5%, 8.1%, and 7.3% of the difference in cancer-specific mortality between NHB and NHW women, respectively. Similar results were noted for overall mortality. CONCLUSIONS Multidisciplinary and multilevel approaches that integrate and address social and biological factors are needed to reduce the disproportionate burden of type II EC mortality in NHB women.
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Affiliation(s)
- Pritesh S Karia
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Yongmei Huang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, United States of America
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, United States of America
| | - Jeanine M Genkinger
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, United States of America.
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Reid HW, Selvan B, Montes de Oca MK, Falkovic M, Malone S, Fish LJ, Wheeler S, Davidson BA. "You start feeling comfortable, you just start sharing:" A qualitative study of patient distress screening in Black and White patients with endometrial cancer. Gynecol Oncol 2023; 168:166-175. [PMID: 36502783 PMCID: PMC9884512 DOI: 10.1016/j.ygyno.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Black patients with endometrial cancer are less likely to express distress and receive referrals for support services compared to White patients. We aim to characterize patient perceptions of the National Comprehensive Cancer Network Distress Thermometer and Problem List (NCCN DT & PL), a common distress screening tool, among Black and White patients with endometrial cancer and determine strategies to improve equity in referral to appropriate support services. METHODS We conducted semi-structured interviews with 15 Black and 15 White patients with endometrial cancer who reported varying levels of distress on the NCCN DT & PL. Interviews were audio-recorded, transcribed, evaluated through staged content analysis, and salient themes were compared by patient race. RESULTS The NCCN DT & PL was generally considered understandable, however the word "distress" could be alienating to participants who considered their stress to be less "drastic." Black participants mentioned fewer negative emotions such as worry and sadness in describing distress and spoke more often of a positive outlook. Additionally, Black participants emphasized the importance of relationship-building with clinicians for open communication on the NCCN DT & PL and clinical encounter. Finally, participants were divided on whether they would alter the way they completed the NCCN DT & PL given more information on cut off scores for referrals, but generally expressed a desire for more direct offers of support services. CONCLUSIONS Relationship-building, open communication around emotion, and longitudinal direct offers of support emerged as avenues to reduce inequities in referral to supportive services for patients with endometrial cancer.
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Affiliation(s)
- Hadley W Reid
- Duke University School of Medicine, DUMC 3710, Durham, NC 27710, USA.
| | - Bharathi Selvan
- Duke University School of Medicine, DUMC 3710, Durham, NC 27710, USA.
| | - Mary Katherine Montes de Oca
- Department of Obstetrics and Gynecology, Duke University School of Medicine, 2608 Erwin Rd, STE 210, Durham, NC 27710, USA.
| | - Margaret Falkovic
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University School of Medicine, Box 2715, Durham, NC 27710, USA.
| | - Shauna Malone
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701, USA..
| | - Laura J Fish
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University School of Medicine, Box 2715, Durham, NC 27710, USA; Department of Family Medicine and Community Health, Duke University School of Medicine, DUMC 2914, Durham, NC 27710, USA.
| | - Sarahn Wheeler
- Division of Maternal Fetal Medicine, Duke University School of Medicine, DUMC 3967, Durham, NC 27710, USA.
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Duke University School of Medicine, DUMC Box 3079, Durham, NC 27710, USA.
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Ran X, Yang H, Yu XQ, Lu L, Wang Y, Ji JS, Xu M, Wei W, Li B, Zeng H. Patterns and trends in the cause of death for patients with endometrial cancer. JNCI Cancer Spectr 2022; 7:6845454. [PMID: 36420983 PMCID: PMC9808774 DOI: 10.1093/jncics/pkac082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/27/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Racial disparities in endometrial cancer have been reported in the United States, but trends and the underlying causes are not well understood. We aimed to examine the trends and contributing factors in racial disparities for causes of death among endometrial cancer patients. METHOD In this population-based cohort study, we identified 139 473 women diagnosed with first, primary endometrial cancer between 1992 to 2018 from the Surveillance, Epidemiology, and End Results Program. We used the "Fine and Gray" method to calculate the cumulative incidence of all-cause and specific-cause death. We used proportional subdistribution hazard (PSH) and cause-specific hazard (CSH) models to quantify the relative risk of Black-White disparities. We performed a mediation analysis to assess the contribution of potential factors to disparities. RESULTS The cumulative incidence of all-cause death decreased in endometrial cancer patients, with estimates at 5 years of 26.72% in 1992-1996 and 22.59% in 2007-2011. Compared with White patients, Black patients persistently had an increased risk of death due to endometrial cancer (PSH hazard ratio [HR] = 2.05, 95% confidence interval [CI] = 1.90 to 2.22; CSH HR = 2.19, 95% CI = 2.00 to 2.40) and causes other than endometrial cancer (PSH HR = 1.23, 95% CI = 1.10 to 1.37; CSH HR = 1.46, 95% CI = 1.31 to 1.63). Grade, histological subtype, surgery utilization, and stage at diagnosis explained 24.4%, 20.1%, 18.4%, and 16.6% of the Black-White disparity in all-cause death, respectively. CONCLUSIONS Although the cumulative incidence of all-cause death decreased, the Black-White gaps persisted in patients with endometrial cancer. Grade and histological subtype had the greatest influence. More efforts are needed to address the disparities.
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Affiliation(s)
| | | | - Xue Qin Yu
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, NSW, Australia
| | - Lingeng Lu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale Cancer Center, Yale University, New Haven, CT, USA
| | - Yixin Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Mengyuan Xu
- Department of Epidemiology and Statistics, Hebei Medical University/Hebei Province Key Laboratory of Environment and Human Health, Shijiazhuang, China
| | - Wenqiang Wei
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Hongmei Zeng
- Correspondence to: Hongmei Zeng, PhD, National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 South Lane, Panjiayuan, Chaoyang District, Beijing 100021, China (e-mail: )
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Cao S, Liao X, Xu K, Xiao H, Shi Z, Zou Y, Li C, Hu Y, Yan S. Development and validation of tumor-size-stratified prognostic nomograms for patients with uterine sarcoma: A SEER database analysis. Cancer Med 2022; 12:1339-1349. [PMID: 35841316 PMCID: PMC9883420 DOI: 10.1002/cam4.5014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/14/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Tumor-size-stratified analysis on the prognosis of uterine sarcoma is insufficient. This study aimed to establish the tumor-size-stratified nomograms to predict the 3- and 5-year overall survival (OS) of patients with uterine sarcoma. METHODS The data analyzed in this study were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. We collected data from patients with uterine sarcoma diagnosed between 2004 and 2015. According to the median tumor size of 7.8 cm, the enrolled patients were divided into two tumor size (TS) groups: TS <7.8 cm and TS ≥7.8 cm. Patients in each group were randomly divided into the training and validation cohorts with a ratio of 7:3. Chi-square test was used to compare differences between categorical variables. Multivariate Cox regression models were used to identify significant predictors. We calculated the concordance index (C-index) and the area under the receiver operating characteristics curve (AUC) to validate the nomograms. RESULTS Compared with TS <7.8 cm group, TS ≥7.8 cm group had more patients of 45-64 years group, higher black race prevalence, higher proportion of myometrium tumor, higher stage, and higher grade; In the TS <7.8 cm training cohort, six variables (age, race, marital status, tumor primary site, stage, and grade) were identified as significantly associated with OS in multivariate analysis. However in the TS ≥7.8 cm training cohort, only four variables (surgery on primary site, tumor size, stage, and grade) were significantly identified; The C-index of two nomograms were 0.80 and 0.73 in training cohorts, respectively, and the AUC values for 3- and 5-year OS predictions in training cohorts were all above 0.80. Similar results were observed in validation cohorts. CONCLUSIONS This study found that the significant prognostic factors were different between two tumor size groups of uterine sarcoma patients. The tumor-size-stratified nomograms, which we constructed and validated, might be useful to predict the probability of survival for patients with uterine sarcoma.
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Affiliation(s)
- Shiyu Cao
- Department of Cancer Prevention and ControlHunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangshaHunan ProvinceChina
| | - Xianzhen Liao
- Department of Cancer Prevention and ControlHunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangshaHunan ProvinceChina
| | - Kekui Xu
- Department of Cancer Prevention and ControlHunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangshaHunan ProvinceChina
| | - Haifan Xiao
- Department of Cancer Prevention and ControlHunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangshaHunan ProvinceChina
| | - Zhaohui Shi
- Department of Cancer Prevention and ControlHunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangshaHunan ProvinceChina
| | - Yanhua Zou
- Department of Cancer Prevention and ControlHunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangshaHunan ProvinceChina
| | - Can Li
- Department of Cancer Prevention and ControlHunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangshaHunan ProvinceChina
| | - Yingyun Hu
- Department of Cancer Prevention and ControlHunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangshaHunan ProvinceChina
| | - Shipeng Yan
- Department of Cancer Prevention and ControlHunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangshaHunan ProvinceChina
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Towner M, Kim JJ, Simon MA, Matei D, Roque D. Disparities in gynecologic cancer incidence, treatment, and survival: a narrative review of outcomes among black and white women in the United States. Int J Gynecol Cancer 2022; 32:931-938. [PMID: 35523443 PMCID: PMC9509411 DOI: 10.1136/ijgc-2022-003476] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
For patients diagnosed with ovarian, uterine, or cervical cancer, race impacts expected outcome, with black women suffering worse survival than white women for all three malignancies. Moreover, outcomes for black women have largely worsened since the 1970s. In this narrative review, we first provide an updated summary of the incidence and survival of ovarian, uterine, and cervical cancer, with attention paid to differences between white and black patients. We then offer a theoretical framework detailing how racial disparities in outcomes for each of the gynecologic malignancies can be explained as the sum result of smaller white-black differences in experience of preventive strategies, implementation of screening efforts, early detection of symptomatic disease, and appropriate treatment. Much research has been published regarding racial disparities in each of these domains, and with this review, we seek to curate the relevant literature and present an updated understanding of disparities between black and white women with gynecologic malignancies.
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Affiliation(s)
- Mary Towner
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - J Julie Kim
- Obstetrics and Gynecology, Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Melissa A Simon
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniela Matei
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dario Roque
- Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Jones W, Tait D, Livasy C, Ganapathi M, Ganapathi R. PLK3 amplification and tumor immune microenvironment of metastatic tumors are linked to adjuvant treatment outcomes in uterine serous cancer. NAR Cancer 2022; 4:zcac026. [PMID: 36177381 PMCID: PMC9513840 DOI: 10.1093/narcan/zcac026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/05/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022] Open
Abstract
Uterine serous carcinoma (USC), an aggressive variant of endometrial cancer representing approximately 10% of endometrial cancer diagnoses, accounts for ∼39% of endometrial cancer-related deaths. We examined the role of genomic alterations in advanced-stage USC associated with outcome using paired primary-metastatic tumors (n = 29) treated with adjuvant platinum and taxane chemotherapy. Comparative genomic analysis of paired primary-metastatic patient tumors included whole exome sequencing and targeted gene expression. Both PLK3 amplification and the tumor immune microenvironment (TIME) in metastatic tumors were linked to time-to-recurrence (TTR) risk without any such association observed with primary tumors. TP53 loss was significantly more frequent in metastatic tumors of platinum-resistant versus platinum-sensitive patients and was also associated with increased recurrence and mortality risk. Increased levels of chr1 breakpoints in USC metastatic versus primary tumors co-occur with PLK3 amplification. PLK3 and the TIME are potential targets for improving outcomes in USC adjuvant therapy.
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Affiliation(s)
- Wendell Jones
- Bioinformatics, Q2 Solutions Genomics , Durham , NC, USA
| | - David Tait
- Levine Cancer Institute, Atrium Health , Charlotte , NC, USA
| | - Chad Livasy
- Carolinas Pathology Group , Charlotte , NC, USA
| | | | - Ram Ganapathi
- Levine Cancer Institute, Atrium Health , Charlotte , NC, USA
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Grubbs A, Barber EL, Roque DR. Healthcare Disparities in Gynecologic Oncology. Adv Oncol 2022; 2:119-128. [PMID: 35669851 PMCID: PMC9165691 DOI: 10.1016/j.yao.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Allison Grubbs
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Emma L Barber
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dario R Roque
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Knisely A, Huang Y, Li Y, Prabhu VS, Wright JD. Adjuvant and First Line Chemotherapy Use for Endometrial Cancer. Gynecol Oncol Rep 2022; 41:101002. [PMID: 35620299 PMCID: PMC9126968 DOI: 10.1016/j.gore.2022.101002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Among subjects who underwent hysterectomy for endometrial cancer, 19% received adjuvant chemotherapy. Platinum and taxane based chemotherapy is the most commonly used adjuvant chemotherapy. Platinum and taxane combination therapy was used in 48% of patients at first recurrence.
Objective The objective of this study was to describe patterns of utilization of cytotoxic, hormonal, and immunotherapy in patients with endometrial cancer in the adjuvant setting and at the time of first recurrence. Methods We identified patients in the IBM MarketScan database with endometrial cancer who underwent hysterectomy from 2011 to 2019. The use of clinically relevant therapeutic agents and combination regimens was determined in the adjuvant setting and at the time of first recurrence. Results A total of 22,632 patients were identified. Of these, 7,147 patients (31.6%) received adjuvant radiation and 4,381 (19.4%) received adjuvant chemotherapy following surgery. Of those who received adjuvant chemotherapy, the most commonly utilized agents were carboplatin (90.3%), paclitaxel (85.8%), cisplatin (9.4%), docetaxel (9.3%), gemcitabine (3.8%), and doxorubicin (2.0%), while bevacizumab was utilized in 1.5% of patients. A combination of platinum and a taxane were utilized as adjuvant therapy in 88.8% of women. Of the cohort, 1,825 patients (8.1%) recurred, of whom 1,017 patients had already received adjuvant chemotherapy. The median time from hysterectomy to initiation of chemotherapy for recurrence was 13.3 months (IQR: 7.6–23.1 months). Overall, platinum and taxane combination therapy was used in 788 (46.8%) of patients with recurrent disease, platinum alone or with other drugs in 194 (11.5%), taxanes alone or with other drugs in 145 (8.6%), and non-platinum and non-taxane based therapy in 31.3%. Conclusions Among patients with endometrial cancer who underwent hysterectomy, platinum-taxane combination chemotherapy was used in almost 90% of patients who received adjuvant chemotherapy while nearly 70% of patients who recurred were treated with platinum or taxane based therapy at first recurrence.
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Abstract
Endometrial cancer is the most common gynaecological malignancy in high income countries and its incidence is rising. Whilst most women with endometrial cancer are diagnosed with highly curable disease and have good outcomes, a significant minority present with adverse clinico-pathological characteristics that herald a poor prognosis. Prognostic biomarkers that reliably select those at greatest risk of disease recurrence and death can guide management strategies to ensure that patients receive appropriate evidence-based and personalised care. The Cancer Genome Atlas substantially advanced our understanding of the molecular diversity of endometrial cancer and informed the development of simplified, pragmatic and cost-effective classifiers with prognostic implications and potential for clinical translation. Several blood-based biomarkers including proteins, metabolites, circulating tumour cells, circulating tumour DNA and inflammatory parameters have also shown promise for endometrial cancer risk assessment. This review provides an update on the established and emerging prognostic biomarkers in endometrial cancer.
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Affiliation(s)
- Kelechi Njoku
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Stoller Biomarker Discovery Centre, University of Manchester, Manchester, United Kingdom
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester, University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Chloe E. Barr
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester, University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Emma J. Crosbie
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester, University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- *Correspondence: Emma J. Crosbie,
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Whetstone S, Burke W, Sheth SS, Brooks R, Cavens A, Huber-Keener K, Scott DM, Worly B, Chelmow D. Health Disparities in Uterine Cancer: Report From the Uterine Cancer Evidence Review Conference. Obstet Gynecol 2022; 139:645-59. [PMID: 35272301 DOI: 10.1097/AOG.0000000000004710] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/02/2021] [Indexed: 12/27/2022]
Abstract
The Centers for Disease Control and Prevention recognized the need for educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. The American College of Obstetricians and Gynecologists convened a panel of experts in evidence review from the Society for Academic Specialists in General Obstetrics and Gynecology and content experts from the Society of Gynecologic Oncology to review relevant literature, best practices, and existing practice guidelines for the development of evidence-based educational materials for women's health care clinicians about uterine cancer. This article is the evidence summary of the literature review of health disparities and inequities related to uterine cancer. Substantive knowledge gaps are noted and summarized to provide guidance for future research.
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Corey L, Cote ML, Ruterbusch JJ, Vezina A, Winer I. Disparities in adjuvant treatment of high-grade endometrial cancer in the Medicare population. Am J Obstet Gynecol 2022; 226:541.e1-541.e13. [PMID: 34736911 DOI: 10.1016/j.ajog.2021.10.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Black women experience worse survival effects with high-grade endometrial cancer. Differences in adjuvant treatment have been proposed to be major contributors to this disparity. However, little is known about the differences in type or timing of adjuvant treatment as it relates to race and ethnicity in the Medicare population. OBJECTIVE This study aimed to examine patterns of adjuvant therapy and survival for non-Hispanic Black women vs non-Hispanic White women and Hispanic women who have undergone surgery for high-grade endometrial cancer in the Medicare population. STUDY DESIGN We used the Medicare-linked Surveillance, Epidemiology, and End Results database to identify women who underwent surgery as a primary treatment for uterine grade 3 endometrioid adenocarcinoma, carcinosarcoma, clear-cell carcinoma, or serous carcinoma between the years 2000 and 2015. Women who did not identify as White or Black race or Hispanic ethnicity were excluded. Multinomial logistic regression was used to estimate odds ratios and 95% confidence intervals for receiving a treatment delay or not receiving adjuvant treatment (compared with those who received adjuvant treatment within 12 weeks) adjusted for clinical and demographic characteristics. Overall survival was stratified by race and ethnicity, route of surgery, operative complications, and type and timing of adjuvant therapy, which were analyzed using the Kaplan-Meier method. Cox proportional-hazards regression was used to estimate the hazard ratio of death by race and ethnicity adjusted for known predictors and surgical outcomes and adjuvant therapy patterns. RESULTS A total of 12,201 women met the study inclusion criteria. Non-Hispanic Black patients had a significantly worse 5-year overall survival than Hispanic and non-Hispanic White patients (30.9 months vs 51.0 months vs 53.6 months, respectively). Approximately 632 of 7282 patients (8.6%) who received adjuvant treatment experienced a treatment delay. Delay in treatment of ≥12 weeks was significantly different by race and ethnicity (P=.034), with 12% of Hispanic, 9% of non-Hispanic Black, and 8% of non-Hispanic White women experiencing a delay. After adjustment for the number of complications, age, histology (endometrioid vs nonendometroid), International Federation of Gynecology and Obstetrics stage, marital status, comorbidity count, surgical approach, lymph node dissection, and urban-rural code, Hispanic women had a 71% increased risk of treatment delay (odds ratio, 1.71; 95% confidence interval, 1.23-2.38) for all stages of disease. In the same model, non-Hispanic Black race was independently predictive of decreased use of adjuvant treatment for the International Federation of Gynecology and Obstetrics stage II and higher (odds ratio, 1.32; 95% confidence interval, 1.04-1.68). Non-Hispanic Black race, number of perioperative complications, and nonendometrioid histology were predictive of worse survival in univariate models. Treatment delay was not independently predictive of worse 1- or 5-year survival at any stage. CONCLUSION Non-Hispanic Black race was predictive of worse 5-year survival across all stages and was associated with omission of adjuvant treatment in International Federation of Gynecology and Obstetrics stage II or higher high-grade endometrial cancer. In unadjusted analyses, patients who experience treatment omission or delay experienced poorer overall survival, but these factors were not independently associated in multivariate analyses. This study suggests that race and ethnicity are independently associated with the type and timing of adjuvant treatment in patients with high-grade endometrial cancer. Further efforts to identify specific causes of barriers to care and timely treatment are imperative.
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Bhutada JKS, Hwang AE, Liu L, Tsai KY, Deapen D, Freyer DR. Survival of Adolescents and Young Adults with Prevalent Poor-Prognosis Metastatic Cancers: A Population-Based Study of Contemporary Patterns and Their Implications. Cancer Epidemiol Biomarkers Prev 2022; 31:900-908. [PMID: 35086824 PMCID: PMC8983591 DOI: 10.1158/1055-9965.epi-21-0913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/11/2021] [Accepted: 01/21/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Although survival has improved dramatically for most adolescents and young adults (AYA; 15-39 years old) with cancer, it remains poor for those presenting with metastatic disease. To better characterize this subset, we conducted a landscape survival comparison with older adults (40-79 years). METHODS Using Surveillance, Epidemiology, and End Results Program data from 2000 to 2016, we examined incident cases of poor-prognosis metastatic cancers (5-year survival < 50%) among AYAs (n = 11,518) and older adults (n = 345,681) and compared cause-specific survival by sociodemographic characteristics (race/ethnicity, sex, and socioeconomic status). Adjusted HRs (aHR) for death from metastatic disease [95% confidence intervals (95% CI)] were compared between AYAs and older adults (Pint). RESULTS AYAs had significantly better survival than older adults for every cancer site except kidney, where it was equivalent (range of aHRs = 0.91; 95% CI, 0.82-1.02 for kidney cancer to aHR = 0.33; 95% CI, 0.26-0.42 for rhabdomyosarcoma). Compared with their older adult counterparts, greater survival disparities existed for AYAs who were non-Hispanic Black with uterine cancer (aHR = 2.20; 95% CI, 1.25-3.86 versus aHR = 1.40; 95% CI, 1.28-1.54; Pint = 0.049) and kidney cancer (aHR = 1.51; 95% CI, 1.15-1.98 versus aHR = 1.10; 95% CI, 1.03-1.17; Pint = 0.04); non-Hispanic Asian/Pacific Islanders with ovarian cancer (aHR = 1.47; 95% CI, 1.12-1.93 versus aHR = 0.89; 95% CI, 0.84-0.95; Pint<0.001); and males with colorectal cancer (aHR = 1.21; 95% CI, 1.10-1.32 versus aHR = 1.08; 95% CI, 1.06-1.10; Pint = 0.045). CONCLUSIONS AYAs diagnosed with these metastatic cancers have better survival than older adults, but outcomes remain dismal. IMPACT Overcoming the impact of metastasis in these cancers is necessary for continuing progress in AYA oncology. Sociodemographic disparities affecting AYAs within kidney, uterine, ovarian, and colorectal cancer could indicate plausible effects of biology, environment, and/or access and should be explored.
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Affiliation(s)
| | - Amie E. Hwang
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
- Los Angeles Cancer Surveillance Program, Los Angeles, CA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lihua Liu
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
- Los Angeles Cancer Surveillance Program, Los Angeles, CA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kai-ya Tsai
- Los Angeles Cancer Surveillance Program, Los Angeles, CA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Dennis Deapen
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
- Los Angeles Cancer Surveillance Program, Los Angeles, CA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David R. Freyer
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Liao CI, Caesar MA, Lee D, Chan A, Darcy KM, Tian C, Kapp DS, Chan JK. Increasing incidence of uterine carcinosarcoma: A United States Cancer Statistics study. Gynecol Oncol Rep 2022; 40:100936. [PMID: 35169605 PMCID: PMC8829560 DOI: 10.1016/j.gore.2022.100936] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/30/2022] Open
Abstract
The incidence of uterine carcinosarcoma increased over the past 17 years. Black women in the South ages 70–74 had the highest incidence. Uterine carcinosarcoma increased annually by 2.6% in Hispanic women.
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Reid HW, Broadwater G, Montes de Oca MK, Selvan B, Fayanju O, Havrilesky LJ, Davidson BA. Distress screening in endometrial cancer leads to disparity in referral to support services. Gynecol Oncol 2022; 164:622-627. [PMID: 35016785 PMCID: PMC8891066 DOI: 10.1016/j.ygyno.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/01/2021] [Accepted: 01/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Racial disparities in survival from endometrial cancer (EC) are well known. Cancer distress has also been associated with worse clinical outcomes. We characterized the association between race/ethnicity, patient distress reported on the National Comprehensive Cancer Network Distress Thermometer and Problem List (NCCN DT & PL), referral to support services, time to surgery, and acceptance of adjuvant therapy in patients with EC. METHODS We included patients presenting at an academic gynecologic oncology practice from 1/2013-6/2020 who had not received prior EC-directed treatment. Demographics, NCCN DT scores, and treatment details were abstracted from the electronic medical record. Difference in initial DT scores by race/ethnicity and treatment type was tested using general linear modeling. The significance of interaction effects was tested using linear mixed models and logistic regression. RESULTS 393 non-Hispanic White (NHW) and 134 non-Hispanic Black (NHB) patients were included. Median distress scores were higher in NHW patients compared to NHB patients (4 vs. 2, p < 0.001); 51% of NHW patients qualified for referral to support services compared to 40% of NHB patients (p = 0.03). Distress scores were highest at initial appointment and declined over time in NHW patients regardless of treatment, but were initially low and remained low over time in NHB patients. There was no association of initial distress score with time to surgery or acceptance of adjuvant treatment (p-values >0.25). CONCLUSIONS An observed difference in NCCN DT leads to racial disparities in referral to support services. The NCCN DT may not adequately measure distress in NHB women with EC.
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Affiliation(s)
- Hadley W Reid
- Duke University School of Medicine, DUMC 3710, Durham, NC 27710, USA.
| | - Gloria Broadwater
- Duke Cancer Institute Biostatistics, Duke University Medical Center, DUMC Box 2717, Durham, NC, USA.
| | - Mary Katherine Montes de Oca
- Department of Obstetrics and Gynecology, Duke University School of Medicine, 2608 Erwin Rd, STE 210, Durham, NC 27710, USA.
| | - Bharathi Selvan
- Duke University School of Medicine, DUMC 3710, Durham, NC 27710, USA.
| | - Oluwadamilola Fayanju
- Department of Surgery, Duke University School of Medicine, DUMC 3513, Durham, NC 27710, USA.
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Duke University School of Medicine, DUMC Box 3079, Durham, NC, 27710, USA.
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Duke University School of Medicine, DUMC Box 3079, Durham, NC, 27710, USA.
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Torres TK, Chase DM, Salani R, Hamann HA, Stone J. Implicit biases in healthcare: implications and future directions for gynecologic oncology. Am J Obstet Gynecol 2022:S0002-9378(22)00005-9. [PMID: 35026128 DOI: 10.1016/j.ajog.2021.12.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/09/2021] [Accepted: 12/24/2021] [Indexed: 11/21/2022]
Abstract
Health disparities have been found among patients with gynecologic cancers, with the greatest differences arising among groups based on racial, ethnic, and socioeconomic factors. Although there may be multiple social barriers that can influence health disparities, another potential influence may stem from healthcare system factors that unconsciously perpetuate bias toward patients who are racially and socioeconomically disadvantaged. More recent research suggested that providers hold these implicit biases (automatic and unconscious attitudes) for stigmatized populations with cancer, with emerging evidence for patients with gynecologic cancer. These implicit biases may guide providers' communication and medical judgments, which, in turn, may influence the patient's satisfaction with and trust in the provider. This narrative review consolidated the current research on implicit bias in healthcare, with a specific emphasis on oncology professionals, and identified future areas of research for examining and changing implicit biases in the field of gynecologic oncology.
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Marima R, Hull R, Mbeje M, Molefi T, Mathabe K, Elbagory AM, Demetriou D, Dlamini Z. Role of Precision Oncology in Type II Endometrial and Prostate Cancers in the African Population: Global Cancer Genomics Disparities. Int J Mol Sci 2022; 23:628. [PMID: 35054814 DOI: 10.3390/ijms23020628] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023] Open
Abstract
Precision oncology can be defined as molecular profiling of tumors to identify targetable alterations. Emerging research reports the high mortality rates associated with type II endometrial cancer in black women and with prostate cancer in men of African ancestry. The lack of adequate genetic reference information from the African genome is one of the major obstacles in exploring the benefits of precision oncology in the African context. Whilst external factors such as the geography, environment, health-care access and socio-economic status may contribute greatly towards the disparities observed in type II endometrial and prostate cancers in black populations compared to Caucasians, the contribution of African ancestry to the contribution of genetics to the etiology of these cancers cannot be ignored. Non-coding RNAs (ncRNAs) continue to emerge as important regulators of gene expression and the key molecular pathways involved in tumorigenesis. Particular attention is focused on activated/repressed genes and associated pathways, while the redundant pathways (pathways that have the same outcome or activate the same downstream effectors) are often ignored. However, comprehensive evidence to understand the relationship between type II endometrial cancer, prostate cancer and African ancestry remains poorly understood. The sub-Saharan African (SSA) region has both the highest incidence and mortality of both type II endometrial and prostate cancers. Understanding how the entire transcriptomic landscape of these two reproductive cancers is regulated by ncRNAs in an African cohort may help elucidate the relationship between race and pathological disparities of these two diseases. This review focuses on global disparities in medicine, PCa and ECa. The role of precision oncology in PCa and ECa in the African population will also be discussed.
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Lin DI, Fine A, Danziger NA, Huang RSP, Mata DA, Decker B, Killian JK, Ramkissoon SH, Lechpammer M, Janovitz T, Ross JS, Sokol ES, Elvin JA. Molecular analysis of endometrial serous carcinoma reveals distinct clinicopathologic and genomic subgroups. Gynecol Oncol 2022; 164:558-565. [PMID: 34998597 DOI: 10.1016/j.ygyno.2021.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/17/2021] [Accepted: 12/26/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Endometrial serous carcinoma (EMSC) is an aggressive variant of uterine cancer with limited therapeutic options. We sought to define distinct clinicopathologic and genomic EMSC subgroups. METHODS We retrospectively analyzed 2159 EMSC and 2346 endometrioid-type endometrial carcinomas (EEC) tissue specimens that had undergone comprehensive genomic profiling (CGP) via the FoundationOne CDx assay during routine clinical care. High tumor mutational burden (TMB) was defined as ≥10mut/Mb using the FDA-approved CDx cutoff for pembrolizumab. Microsatellite instability (MSI) was determined on 95 loci. Evidence of homologous recombination deficiency (HRD) was determined via genomic loss of heterozygosity (gLOH), a validated HRD detection method for predicting PARP inhibitor effectiveness in ovarian carcinoma. High gLOH was defined as ≥16%. RESULTS A genomic analysis of 2159 EMSCs revealed a predominance of TP53 mutations, microsatellite stability, low tumor mutational burden (TMB), and recurrent alterations of PIK3CA, PPP2R1A, ERBB2, CCNE1, FBXW7 and MYC. Evidence of HRD via high gLOH was identified in 22% of EMSCs. BRCA1 and BRCA2 alterations, as well as unique SET (solid, pseudo-endometrioid, and transitional cell-like) variant morphology, were enriched in HRD-EMSC. There was an increased frequency of CCNE1 amplification, a lower prevalence of PIK3CA and PPP2R1A alterations, and no differences in HRD, MSI or TMB biomarker frequencies in patients of predicted African ancestry. EMSC exhibited distinct gene mutation frequencies and MSI, TMB and gLOH biomarker signatures compared to a cohort 2346 EEC. CONCLUSIONS Molecularly defined subgroups provide a framework to test the susceptibility of EMSC to targeted therapies in specific genetic settings (e.g. HRD, PIK3CA, PPP2R1A, ERBB2, MYC, CCNE1).
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Affiliation(s)
- Douglas I Lin
- Foundation Medicine Inc., Cambridge, MA, United States of America.
| | - Alexander Fine
- Foundation Medicine Inc., Cambridge, MA, United States of America
| | | | | | - Douglas A Mata
- Foundation Medicine Inc., Cambridge, MA, United States of America
| | - Brennan Decker
- Foundation Medicine Inc., Cambridge, MA, United States of America
| | | | - Shakti H Ramkissoon
- Foundation Medicine Inc., Morrisville, NC, United States of America; Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Mirna Lechpammer
- Foundation Medicine Inc., Cambridge, MA, United States of America
| | - Tyler Janovitz
- Foundation Medicine Inc., Cambridge, MA, United States of America
| | - Jeffrey S Ross
- Foundation Medicine Inc., Cambridge, MA, United States of America; Upstate Medical University, Syracuse, NY, United States of America
| | - Ethan S Sokol
- Foundation Medicine Inc., Cambridge, MA, United States of America
| | - Julia A Elvin
- Foundation Medicine Inc., Cambridge, MA, United States of America
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Abstract
Although endometrial cancer management remains challenging, a deeper understanding of the genetic diversity as well as the drivers of the various pathogenic states of this disease has led to development of divergent management approaches in an effort to improve therapeutic precision in this complex malignancy. This comprehensive review provides an update on the epidemiology, pathophysiology, diagnosis and molecular classification, recent advancements in disease management, as well as important patient quality-of-life considerations and emerging developments in the rapidly evolving therapeutic landscape of endometrial cancers.
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Varghese RS, Barefoot ME, Jain S, Chen Y, Zhang Y, Alley A, Kroemer AH, Tadesse MG, Kumar D, Sherif ZA, Ressom HW. Integrative Analysis of DNA Methylation and microRNA Expression Reveals Mechanisms of Racial Heterogeneity in Hepatocellular Carcinoma. Front Genet 2021; 12:708326. [PMID: 34557219 PMCID: PMC8453167 DOI: 10.3389/fgene.2021.708326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
Pathologic alterations in epigenetic regulation have long been considered a hallmark of many cancers, including hepatocellular carcinoma (HCC). In a healthy individual, the relationship between DNA methylation and microRNA (miRNA) expression maintains a fine balance; however, disruptions in this harmony can aid in the genesis of cancer or the propagation of existing cancers. The balance between DNA methylation and microRNA expression and its potential disturbance in HCC can vary by race. There is emerging evidence linking epigenetic events including DNA methylation and miRNA expression to cancer disparities. In this paper, we evaluate the epigenetic mechanisms of racial heterogenity in HCC through an integrated analysis of DNA methylation, miRNA, and combined regulation of gene expression. Specifically, we generated DNA methylation, mRNA-seq, and miRNA-seq data through the analysis of tumor and adjacent non-tumor liver tissues from African Americans (AA) and European Americans (EA) with HCC. Using mixed ANOVA, we identified cytosine-phosphate-guanine (CpG) sites, mRNAs, and miRNAs that are significantly altered in HCC vs. adjacent non-tumor tissue in a race-specific manner. We observed that the methylome was drastically changed in EA with a significantly larger number of differentially methylated and differentially expressed genes than in AA. On the other hand, the miRNA expression was altered to a larger extent in AA than in EA. Pathway analysis functionally linked epigenetic regulation in EA to processes involved in immune cell maturation, inflammation, and vascular remodeling. In contrast, cellular proliferation, metabolism, and growth pathways are found to predominate in AA as a result of this epigenetic analysis. Furthermore, through integrative analysis, we identified significantly differentially expressed genes in HCC with disparate epigenetic regulation, associated with changes in miRNA expression for AA and DNA methylation for EA.
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Affiliation(s)
- Rency S Varghese
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Megan E Barefoot
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Sidharth Jain
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Yifan Chen
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Yunxi Zhang
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Amber Alley
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | | | - Mahlet G Tadesse
- Department of Mathematics and Statistics, Georgetown University, Washington, DC, United States
| | - Deepak Kumar
- Department of Pharmaceutical Sciences, North Carolina Central University, Durham, NC, United States
| | - Zaki A Sherif
- Department of Biochemistry and Molecular Biology, College of Medicine, Howard University, Washington, DC, United States
| | - Habtom W Ressom
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
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Straubhar AM, Parsons MW, Francis S, Gaffney D, Maurer KA. Refusal of surgery and survival outcomes in endometrial cancer. Int J Gynecol Cancer 2021; 31:1236-1241. [PMID: 34385179 DOI: 10.1136/ijgc-2021-002692] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/28/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The goal of this study was to determine the impact refusal of surgery has on overall survival in patients with endometrial cancer. METHODS From January 2004 to December 2015, the National Cancer Database was queried for patients with pathologically proven endometrial cancer who were recommended surgery and refused. Inverse probability of treatment weighting was used to account for differences in baseline characteristics between patients who underwent surgery and those who refused. Kaplan-Meier analyses and doubly robust estimation with multivariate Cox proportional hazards modeling were used to analyze overall survival. RESULTS Of the 300 675 patients identified, 534 patients (0.2%) were recommended surgical treatment but refused: 18% (95/534) were age ≤40 years. The 5-year overall survival for all patients who refused surgery was significantly decreased compared with patients who underwent surgery (29.2% vs 71.9%, P<0.01). This was demonstrated at ages 41-64 years (65.5% vs 91.0%, P<0.01) and ≥65 years (23.4% vs 75.3%, P<0.01). The 5-year overall survival did not meet statistical significance at age ≤40 years (90.1% vs 87.8% P<0.19). However, there were few patients in this cohort. On multivariate analysis, factors associated with refusal of surgery included: Medicaid insurance, Black race, Hispanic Race, Charlson Comorbidity Index scores of 2 or greater, stage II or III, and if patient received external beam radiation therapy alone. Factors associated with undergoing surgery included: age greater than 41, stage IB, and if the patient received brachytherapy. CONCLUSIONS Refusal of surgery for endometrial cancer is uncommon and leads to decreased overall survival.
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Affiliation(s)
- Alli M Straubhar
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, Utah, USA
| | - Matthew W Parsons
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Samual Francis
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - David Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah, USA.,University of Utah, Salt Lake City, Utah, USA
| | - Kathryn A Maurer
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, Utah, USA
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Londero AP, Parisi N, Tassi A, Bertozzi S, Cagnacci A. Hormone Replacement Therapy in Endometrial Cancer Survivors: A Meta-Analysis. J Clin Med 2021; 10:3165. [PMID: 34300331 DOI: 10.3390/jcm10143165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study is to investigate the effect of hormone therapy (HT) on the oncological outcomes of endometrial cancer (EC) survivors. A systematic literature review was conducted in July 2021 to identify studies detailing the effect size for the relationship between HT use in EC and oncological outcomes (survival and disease recurrence). This included studies that evaluated the different recurrence rates among women treated for EC who subsequently underwent HT and those who did not. The collected studies were evaluated for quality, heterogeneity, and publication bias, and a pooled odds ratio (OR) or hazard ratio (HR) was calculated with a confidence interval of 95% (95% CI). In total, 5291 studies were collated, and after the review process, one randomized trial and seven observational studies were included, comprising 1801 EC survivors treated with HT and 6015 controls. The time-dependent analysis could be conducted for four studies, and considering the disease-free survival, the pooled HR of 0.90 (95% CI 0.28 to 2.87) showed no significant differences. However, among Black American women treated with continuous estrogen HT, the HR was 7.58 (95% CI 1.96 to 29.31), showing a significantly increased risk of recurrence for women in this ethnic group. Considering the pooled OR of all included studies 0.63 (95% CI 0.48 to 0.83), a significantly reduced risk of recurrence was found among EC survivors treated with HT. Considering the type of HT, the most risk-reducing was combined estrogen and progestin therapy and the cyclic regimen. Although supporting evidence is based mainly upon observational studies, evidence of no increased risk or even decreased risk was generally found, apart from in Black American women where a significantly increased recurrence risk was evident. The data are rather reassuring for the short-term administration of HT to symptomatic EC survivors. Future studies with a longer follow-up are necessary to better clarify the long-term effects of HT.
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Corey L, Fucinari J, Elshaikh M, Schultz D, Mussallam R, Zaiem F, Daaboul F, Fehmi O, Dyson G, Ruterbusch J, Morris R, Cote ML, Ali-Fehmi R, Bandyopadhyay S. Impact of positive cytology in uterine serous carcinoma: A reassessment. Gynecol Oncol Rep 2021; 37:100830. [PMID: 34345643 PMCID: PMC8319448 DOI: 10.1016/j.gore.2021.100830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/07/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022] Open
Abstract
Prognostic implications of peritoneal cytology in uterine serous cancer are unclear. Positive cytology is not associated with FIGO stage or LVSI. Peritoneal cytology is an independent prognosticator in uterine serous cancer. Positive cytology is independently associated with worse overall survival and ECSS.
Objectives The aim of this study was to evaluate the prognostic value of peritoneal cytology status among other clinicopathological parameters in uterine serous carcinoma (USC). Methods A retrospective study of 148 patients diagnosed with uterine serous carcinoma from 1997 to 2016 at two academic medical centers in the Detroit metropolitan area was done. A central gynecologic pathologist reviewed all available slides and confirmed the histologic diagnosis of each case of USC. We assessed the prognostic impact of various clinicopathological parameters on overall survival (OS) and endometrial cancer-specific survival (ECSS). Those parameters included race, body mass index (BMI), stage at diagnosis, tumor size, lymphovascular invasion (LVSI), peritoneal cytology status, receipt of adjuvant treatment, and comorbidity count using the Charlson Comorbidity Index (CCI). We used Cox proportional hazards models and 95% confidence intervals for statistical analysis. Results Positive peritoneal cytology had a statistically significant effect on OS (HR: 2.09, 95% CI: [1.19, 3.68]) and on ECSS (HR: 2.02, 95% CI: [1.06 – 3.82]). LVSI had a statistically significant effect on both OS (HR: 2.27, 95% CI: [1.14, 4.53]) and ECSS (HR: 3.45, 95% CI: [1.49, 7.99]). Black or African American (AA) race was also found to have a significant effect on both OS (HR: 1.92, 95% CI: [1.07, 3.47]) and ECSS (HR: 2.01, 95% CI: [1.02, 3.98]). Other factors including BMI and tumor size > 1 cm did not show a statistically significant impact on OS or ECSS. Conclusions Peritoneal washings with positive cytology and LVSI are important prognostic tools that may have a significant impact on overall survival in USC and can be used as independent negative prognosticators to help guide adjuvant treatment.
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Affiliation(s)
- Logan Corey
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan.,Karmanos Cancer Institute, Department of Gynecologic Oncology, Detroit, Michigan
| | - Juliana Fucinari
- Karmanos Cancer Institute, Population Sciences and Disparities Research, Detroit, Michigan
| | | | | | - Rami Mussallam
- Wayne State University, School of Medicine, Department of Pathology, Detroit, Michigan
| | - Feras Zaiem
- Wayne State University, School of Medicine, Department of Pathology, Detroit, Michigan
| | - Fayez Daaboul
- Wayne State University, School of Medicine, Department of Pathology, Detroit, Michigan
| | - Omar Fehmi
- University of Michigan, Ann Arbor, Michigan
| | - Greg Dyson
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan
| | - Julie Ruterbusch
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan
| | - Robert Morris
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan.,Karmanos Cancer Institute, Department of Gynecologic Oncology, Detroit, Michigan
| | - Michelle L Cote
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan.,Karmanos Cancer Institute, Population Sciences and Disparities Research, Detroit, Michigan
| | - Rouba Ali-Fehmi
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan
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Zhang N, Wilson B, Enty MA, Ketch P, Ulm MA, ElNaggar AC, Daily L, Tillmanns T. Same-day discharge after robotic surgery for endometrial cancer. J Robot Surg 2021; 16:543-548. [PMID: 34236587 DOI: 10.1007/s11701-021-01253-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/08/2021] [Indexed: 10/20/2022]
Abstract
To assess the safety of same-day discharge (SDD) following robotic-assisted endometrial cancer staging and identify risk factors for postoperative admission in a diverse population. A review of patients who underwent robotic-assisted endometrial cancer staging from April 1, 2017 to April 1, 2019 was performed. Patients were evaluated for SDD if they met the following criteria: tolerating oral intake, voiding spontaneously, ambulating, negative orthostatic vitals, postoperative hemoglobin ≤ 2 g/dL from baseline, pain controlled on oral medications, and desire to be discharged. Risk factors for admission were identified. One hundred eighty-seven patients were identified. SDD criteria were met in 158, of which 132 (83.5%) were discharged same day. Median length of stay was 4.5 h. Reasons for admission despite meeting criteria were late surgery time (n = 15), abnormal vitals (n = 9), and personal concerns (n = 2), with risk factors being age ≥ 68 years (OR 2.72; 95% CI, 1.13-6.59), start time 1400 or later (OR = 11.25; 95% CI, 4.35-29.10), ASA ≥ 4 (OR 23.82; 95% CI, 2.54-223.15), history of CVA/MI (OR 5.61; 95% CI, 1.07-29.52), and operative time ≥ 120 min (OR = 3.83; 95% CI 1.36-10.77). Of the SDD cohort, 2 patients (1.3%) presented to the emergency room within 30 days (postoperative day 5 and 23). SDD following robotic-assisted endometrial cancer staging is safe and feasible. Age ≥ 68 years, surgery start time after 1400, ASA ≥ 4, history of CVA/MI, and operative time ≥ 120 min appear predictive of inpatient admission despite meeting SDD criteria.
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Affiliation(s)
- Naixin Zhang
- Department of Obstetrics and Gynecology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ben Wilson
- Division of Gynecologic Oncology, West Cancer Center and Research Institute, 7945 Wolf River Blvd., Memphis, TN, 38138, USA
| | - Morgan A Enty
- Department of Obstetrics and Gynecology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Peter Ketch
- Department of Obstetrics and Gynecology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael A Ulm
- Division of Gynecologic Oncology, West Cancer Center and Research Institute, 7945 Wolf River Blvd., Memphis, TN, 38138, USA
| | - Adam C ElNaggar
- Division of Gynecologic Oncology, West Cancer Center and Research Institute, 7945 Wolf River Blvd., Memphis, TN, 38138, USA
| | - Laura Daily
- Division of Gynecologic Oncology, West Cancer Center and Research Institute, 7945 Wolf River Blvd., Memphis, TN, 38138, USA
| | - Todd Tillmanns
- Division of Gynecologic Oncology, West Cancer Center and Research Institute, 7945 Wolf River Blvd., Memphis, TN, 38138, USA.
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Fucinari J, Elshaikh MA, Ruterbusch JJ, Khalil R, Dyson G, Shultz D, Ali-Fehmi R, Cote ML. The impact of race, comorbid conditions and obesity on survival endpoints in women with high grade endometrial carcinoma. Gynecol Oncol 2021; 162:134-141. [PMID: 33985795 DOI: 10.1016/j.ygyno.2021.04.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/26/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To estimate overall survival, disease-specific survival, and progression-free survival among high grade endometrial carcinoma cases and to determine factors impacting survival for non-Hispanic white and non-Hispanic black women. METHODS We identified high grade endometrial carcinoma cases among non-Hispanic white and non-Hispanic black women from ongoing institutional studies, and determined eligibility through medical record and pathologic review. We estimated effects of demographic and clinical variables on survival outcomes using Kaplan Meier methods and Cox proportional hazards modelling. RESULTS Non-Hispanic Black women with BMI <25.0 had poorest overall survival compared to non-Hispanic white women with BMI <25.0 (HR 3.03; 95% CI [1.35, 6.81]), followed by non-Hispanic black women with BMI 25.0+ (HR 2.43; 95% CI [1.28, 4.60]). A similar pattern emerged for disease-specific survival. Non-Hispanic black women also had poorer progression-free survival than non-Hispanic white women (HR 1.40; 95% CI [1.01, 1.93]). Other significant factors impacting survival outcomes included receipt of National Cancer Center Network (NCCN) guideline-concordant treatment (GCT), earlier stage at diagnosis, and fewer comorbid conditions. CONCLUSIONS BMI and race interact and modify the association with high grade endometrial carcinoma survival. Other potentially modifiable factors, such as reducing comorbidities and increasing access to GCT will potentially improve survival after diagnosis of high grade endometrial carcinomas. A better understanding of the molecular drivers of these high grade carcinomas may lead to targeted therapies that reduce morbidity and mortality associated with these aggressive tumors.
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Affiliation(s)
- Juliana Fucinari
- Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA
| | | | - Julie J Ruterbusch
- Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA
| | - Remonda Khalil
- Henry Ford Hospital, Department of Radiation Oncology, Detroit, MI, USA
| | - Gregory Dyson
- Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA; Karmanos Cancer Institute, Population Studies and Disparities Research Program, Detroit, MI, USA
| | - Daniel Shultz
- Henry Ford Hospital, Department of Pathology, Detroit, MI, USA
| | - Rouba Ali-Fehmi
- Wayne State University School of Medicine, Department of Pathology, Detroit, MI, USA; Karmanos Cancer Institute, Tumor Biology and Microenvironment Program, Detroit, MI, USA
| | - Michele L Cote
- Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA; Karmanos Cancer Institute, Population Studies and Disparities Research Program, Detroit, MI, USA.
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Anderson C, Bae-Jump VL, Broaddus RR, Olshan AF, Nichols HB. Long-term Patterns of Excess Mortality among Endometrial Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2021; 30:1079-1088. [PMID: 33737298 DOI: 10.1158/1055-9965.epi-20-1631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/12/2021] [Accepted: 03/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We investigated excess mortality after endometrial cancer using conditional relative survival estimates and standardized mortality ratios (SMR). METHODS Women diagnosed with endometrial cancer during 2000-2017 (N = 183,153) were identified in the Surveillance Epidemiology and End Results database. SMRs were calculated as observed deaths among endometrial cancer survivors over expected deaths among demographically similar women in the general U.S. POPULATION Five-year relative survival was estimated at diagnosis and each additional year survived up to 12 years post-diagnosis, conditional on survival up to that year. RESULTS For the full cohort, 5-year relative survival was 87.7%, 96.2%, and 97.1% at 1, 5, and 10 years post-diagnosis, respectively. Conditional 5-year relative survival first exceeded 95%, reflecting minimal excess mortality compared with the general population, at 4 years post-diagnosis overall. However, in subgroup analyses, conditional relative survival remained lower for Black women (vs. White) and for those with regional/distant stage disease (vs. localized) throughout the study period. The overall SMR for all-cause mortality decreased from 5.90 [95% confidence interval (CI), 5.81-5.99] in the first year after diagnosis to 1.16 (95% CI, 1.13-1.19) at 10+ years; SMRs were consistently higher for non-White women and for those with higher stage or grade disease. CONCLUSIONS Overall, endometrial cancer survivors had only a small survival deficit beyond 4 years post-diagnosis. However, excess mortality was greater in magnitude and persisted longer into survivorship for Black women and for those with more advanced disease. IMPACT Strategies to mitigate disparities in mortality after endometrial cancer will be needed as the number of survivors continues to increase.
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Affiliation(s)
- Chelsea Anderson
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina.
| | - Victoria L Bae-Jump
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Russell R Broaddus
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
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