Disparity in survival between white and African American patients with uterine serous carcinoma: Changes in clinical characteristics, pattern of care and outcome over time from 1988 to 2011

ObjectiveThe objectives of this study were to evaluate the rates of chemotherapy and radiotherapy delivery in the treatment of uterine serous carcinoma in the Medicare population and to compare clinical outcomes in treated and untreated patients.MethodsThe linked Surveillance, Epidemiology, and End Results and Medicare databases were queried to identify patients with a diagnosis of uterine serous carcinoma between 1992 and 2009. The impact of chemotherapy on survival was analyzed using the Kaplan-Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model.ResultsA total of 2188 patients met study eligibility criteria. Stages I, II, III, and IV diseases accounted for 890 (41%), 174 (8%), 470 (21%), and 654 (30%) of the study population, respectively. Chemotherapy, radiotherapy, both, or none, were administered as adjuvant therapy in 635 (29%), 536 (24%), 308 (14%), and 709 (32%) of the study population, respectively. Use of chemotherapy became more frequent over time. Over the study period, and after adjusting for race, time of diagnosis, SEER registry, marital status, stage, age, surgery, lymph node dissection, socioeconomic status, and comorbidity index, there was an association between receipt of radiotherapy alone (hazard ratio [HR], 1.3; 95% CI, 1.04–1.67) and not receiving any treatment (HR, 1.5; 95% CI, 1.2–2.01) and worst survival. Survival was not improved over time.ConclusionAlthough adjuvant chemotherapy and combination treatment with chemotherapy and radiation were associated with improved survival in our model, there was no significant improvement in survival over time.

Download Full-text

miRNA profiling in a case: Control study of African American women with uterine serous carcinoma (USC).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e17116 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e17116-e17116

Author(s):

Larissa Janeen Lee ◽

Brooke E. Howitt ◽

Wojciech Fendler ◽

Konrad Stawiski ◽

Paula Bu ◽

...

Keyword(s):

African American ◽

Disease Recurrence ◽

Differentially Expressed ◽

Serous Carcinoma ◽

Multiple Testing Correction ◽

Normal Endometrium ◽

Histologic Subtype ◽

Mirna Profiling ◽

Uterine Serous Carcinoma ◽

Tcga Dataset

e17116 Background: USC is an aggressive subtype of endometrial cancer associated with worse outcomes in African American patients. We evaluated differences in tumor miRNA expression by race, clinical and tumor characteristics, and survival outcomes. Methods: FFPE tumor tissue from hysterectomy specimens was identified for 29 African American cases. Case matching was performed by computer-based random assignment in a 1:1 ratio with Caucasian controls based on age ( < 70 vs. ≥70 years), stage (FIGO I/II vs. III/IV) and histologic subtype (pure vs. mixed). RNA was extracted from 77 specimens with sufficient tumor cellularity (54 tumors and 23 matched normal endometrium). miRNA array profiling was performed by microRNA Hi-Power Labeling (Hy3/Hy5) and hybridization to miRCURY LNA microRNA Array 7th Gen (Exiqon, Denmark). Analysis was performed with R/Bioconductor using a moderated t-statistic with multiple testing correction. Validation was done using the TCGA dataset. Results: Clinical and treatment characteristics were similar for cases and controls, although use of adjuvant radiation was less common in African Americans (p = 0.03). With a median follow-up of 43 months, 17 patients had recurrent or progressive disease. DFS and OS rates were similar by race (both logrank p > 0.5). Of 968 miRNAs analyzed, 649 were differentially expressed in normal endometrium vs. tumor. When compared by race, histologic subtype, stage or presence of LVI, no differentially expressed miRNAs were identified. In patients with disease recurrence at 3 years, miR-223 was significantly upregulated (fold change 1.5; p = 0.002). In validation using a TCGA dataset of 131 patients with mixed (n = 22) or pure serous (n = 109) histology, increased miR-223 expression ( > median) was associated with worse overall survival (HR 2.47; 95%CI 0.9-6.6). After adjustment for patient age and BMI, upregulation of miR-223 was a significant risk factor for death (adjusted HR 2.94; 95%CI 1.01-8.52). Conclusions: Upregulation of miR-223 was associated with disease recurrence in a cohort of women with uterine serous carcinoma and validated by TCGA data. miRNA profiling did not identify biological differences between African American and Caucasian patients.

Download Full-text

Clinicopathologic and molecular genetic comparison of primary uterine serous adenocarcinomas from African American and Caucasian women.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19092 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19092-e19092

Author(s):

Aifen Wang ◽

Youguo Chen ◽

Robert W. Holloway ◽

Zhe Pei ◽

Jinsong Yang ◽

...

Keyword(s):

African American ◽

Molecular Genetic ◽

Myometrial Invasion ◽

Progression Free Survival ◽

Tumor Grade ◽

Figo Stage ◽

Serous Carcinoma ◽

Clinicopathologic Features ◽

Uterine Serous Carcinoma ◽

Caucasian Women

e19092 Background: The study aimed to identify whether there were racial disparities in the clinicopathologic features and genetic mutation characteristics between African American (AA) and Caucasian women with uterine serous carcinoma. Methods: Clinicopathologic features, molecular genetic data of patients with uterine serous carcinoma were obtained from The Cancer Genome Atlas (TCGA), including age of diagnosis, body mass index (BMI), tumor grade, FIGO stage, myometrial invasion, lymph node involvement, overall survival and progression free survival. MLH1, MSH2, MSH6, PMS2, BRCA1, BRCA2, CHEK2, TP53 mutations were involved. A statistical analysis of these parameters was performed for AA and Caucasian women. Results: 44 AA and 97 Caucasian patients with uterine serous carcinoma were analyzed. There were no PMS2 and BRCA2mutations in tumors of African American patients. Compared to Caucasian patients, tumors from AA patients had no statistically significant differences in Lynch syndrome related genes ( MSH2, MSH6, PMS2) (4.5% versus 14.3%, p = 0.149) and HR pathway genes ( BRCA1, BRCA2, CHEK2) (9.1% versus 19.6%, p = 0.09). Tumors from AA patients had no statistically significant differences in alterations of the TP53 gene (79.5% versus 71.3%, p = 0.312). There were no statistically significant differences between the two groups regarding age at diagnosis, BMI, tumor histology, tumor grade, lymph node involvement, myometrial invasion, FIGO stage, overall survival or progression-free survival between the two groups ( p > 0.05). Conclusions: This study identified no statistically significant differences in clinicopathologic features and genetic mutations in AA and Caucasian women with uterine serous carcinomas. Especially, there were no differences in survival identified between two groups. Much larger database may be necessary to be analyzed in future. [Table: see text]

Download Full-text

Treatment Patterns in US Patients Hospitalized With COVID-19 and Pulmonary Involvement

10.31219/osf.io/tb5kn ◽

2020 ◽

Author(s):

Jennie H Best ◽

Amanda M Kong ◽

Emma Kaplan-Lewis ◽

Otis W Brawley ◽

Rachel Baden ◽

...

Keyword(s):

African American ◽

Clinical Characteristics ◽

Pulmonary Involvement ◽

Geographic Region ◽

Treatment Patterns ◽

The South ◽

Inflammatory Drugs ◽

Multiple Treatments ◽

Over Time ◽

White Patients

Introduction: Multiple treatments are being studied in patients with severe coronavirus disease 2019 (COVID-19). This study describes the baseline demographic and clinical characteristics and treatment patterns of US patients hospitalized with a diagnosis of COVID-19 and pulmonary involvement.Methods: From December 1, 2019, through August 27, 2020, patients hospitalized with pulmonary involvement due to COVID-19 (first hospitalization) were identified in the IBM Explorys® electronic health records database comprising patients predominantly from the Midwestern and Southern United States. Demographics, baseline clinical characteristics, and in-hospital medications were assessed. For evaluation of in-hospital medications, results were stratified by race, geographic region, and month of admission. Results: Of 6564 hospitalized patients with COVID-19–related pulmonary involvement, 50.4% were male, and mean (SD) age was 62.6 (16.4) years; 75.2% and 23.6% of patients were from the South and Midwest, respectively, and 50.2% of patients were African American. Overall, the most common medications were corticosteroids (31.3%), nonsteroidal anti-inflammatory drugs (NSAIDs; 28.2%), bronchodilators (22.1%), hydroxychloroquine (19.6%), and remdesivir (13.5%). Compared with African American patients, a numerically higher proportion of White patients received dexamethasone (19.7% vs 31.8%, respectively), NSAIDs (27.1% vs 34.9%), bronchodilators (19.8% vs 29.5%), and remdesivir (9.3% vs 21.0%). Numerically higher proportions of White patients than African American patients received select medications in the South but not in the Midwest. Compared with patients in the South, a numerically higher proportion of patients in the Midwest received dexamethasone (20.1% vs 34.5%, respectively), NSAIDs (19.6% vs 55.7%), bronchodilators (15.9% vs 41.3%), and remdesivir (10.6% vs 23.1%). Inpatient use of hydroxychloroquine decreased over time, whereas use of dexamethasone and remdesivir increased over time. Conclusion: Among US patients predominantly from the South and Midwest hospitalized with COVID-19 and pulmonary involvement, differences were seen in medication use between different races, geographic regions, and months of hospitalization.

Download Full-text

Trends in Survival of Patients With Uterine Serous Carcinoma From 1988 to 2011: A Population-Based Study

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001007 ◽

2017 ◽

Vol 27 (6) ◽

pp. 1155-1164 ◽

Cited By ~ 2

Author(s):

Haider Mahdi ◽

Xiaozhen Han ◽

Laura Moulton ◽

Roberto Vargas

Keyword(s):

Overall Survival ◽

Cox Regression ◽

Uterine Cancer ◽

Stage I ◽

Serous Carcinoma ◽

Adjuvant Radiation ◽

Disease Specific Survival ◽

Uterine Serous Carcinoma ◽

Disease Specific ◽

Over Time

ObjectiveOur study used the Surveillance, Epidemiology, and End Result database to determine if the changes in treatment paradigm observed over the last 2 decades have improved outcomes in patients with uterine serous carcinoma (USC).MethodsWomen with USC were identified using the Surveillance, Epidemiology, and End Result database from 1988 to 2011 (n = 8230) and grouped into 3 cohorts (1988–1997, 1998–2004, and 2005–2011). Disease-specific survival and overall survival were estimated. Kaplan-Meier survival curves and Cox regression models were used.ResultsDisease-specific survival (59 vs 94 months vs not reached;P< 0.001) and overall survival (31 vs 37 vs 45 months;P< 0.001) improved over time. In univariable analyses, only those with stage I–III and those who reside in the Western or Central regions were noted to have improvement over time. In multivariable analyses when adjusting for age, race, marital status, stage, geographic location, cancer-related surgery, extent of lymphadenectomy, and adjuvant radiation, patients who received the diagnosis during 2005 to 2011 were 22% less likely to die of uterine cancer (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.70–0.87;P< 0.001) and 17% less likely to die of any cause (HR, 0.83; 95% CI, 0.76–0.90;P< 0.0001) compared with patients who received a diagnosis during 1988–1997. Similarly, patients who received a diagnosis during 1998–2004 were 15% less likely to die of uterine cancer (HR, 0.85; 95% CI, 0.77–0.94;P= 0.0015) and 10% less likely to die of any cause (HR, 0.90; 95% CI, 0.83–0.97;P= 0.0048) compared with patients who received a diagnosis during 1988–1997.ConclusionsChanges in treatment trends for USC over the last 2 decades have resulted in an improvement in outcome especially those with stage I–III disease.

Download Full-text