Abstract
Investigate racial disparities in outcomes and molecular features in Black and White patients with endometrioid endometrial carcinoma (EEC).
Black and White patients diagnosed with EEC who underwent hysterectomy ± adjuvant treatment in SEER, National Cancer Database (NCDB), the Genomics Evidence Neoplasia Information Exchange (GENIE) project (v.13.0), and eight NCI-sponsored randomized phase III clinical trials (RCTs) were studied. Hazard ratio (HR) and 95% confidence interval (CI) were estimated for cancer-related death (CRD), non-cancer death (NCD), and all-cause death.
Black (n = 4397) vs. White (n = 47,959) patients in SEER had a HR (95% CI) of 2.04 (1.87–2.23) for CRD and 1.22 (1.09–1.36) for NCD. In NCDB, the HR (95% CI) for death in Black (n = 13,468) vs. White (n = 155,706) patients was 1.52 (1.46–1.58) dropping to 1.29 (1.23–1.36) after propensity-score matching for age, comorbidity, income, insurance, grade, stage, LVSI, and treatment. In GENIE, Black (n = 109) vs. White (n = 1780) patients had fewer PTEN, PIK3R1, FBXW7, NF1, mTOR, CCND1, and PI3K-pathway-related gene mutations. In contrast, TP53 and DNA-repair-related gene mutation frequency as well as tumor mutational burden-high status were similar in Black and White patients. In RCTs, Black (n = 187) vs. White (n = 2877) patients were more likely to have advanced or recurrent disease, higher grade, worse performance status and progressive disease. Risk of death in Black vs. White patients in RCTs was 2.19 (1.77–2.71) persisting to 1.32 (1.09–1.61) after matching for grade, stage, and treatment arm while balancing age and performance status.
Differences exist in clinical presentation, outcomes, and molecular features in Black vs. White patients with EEC in real-world registries and RCTs. Targeted-drug development, strategies to modify social determinants, and diverse inclusion in RCTs are approaches to reduce disparities.
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•Risk of cancer-related and non-cancer-related death was 200% and 22% higher in Black vs. White patients with EEC in SEER.•Risk of all-cause death was 1.52 (1.46–1.58) dropping to 1.29 (1.23–1.36) in matched NCDB Black vs. White patients.•Black vs. White patients had fewer PTEN, PIK3R1, FBXW7, NF1, mTOR and CCND1 mutations and similar TMB-high status.•Advanced/recurrent disease, grade 3, and worse performance status were more common in Black vs. White EEC patients in RCTs.•Risk of death in Black vs. White patients in RCTs was 2.19 (1.77–2.71), persisting in matched analysis [1.32 (1.09–1.61)].