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Racial Disparities in Uterine Clear Cell Carcinoma: A Multi-Institution Study
  1. Zaid R. Al-Wahab, MD*,
  2. Sanjeev Kumar, MD,
  3. David G. Mutch, MD,
  4. Sean C. Dowdy, MD,
  5. Sharon A. Hensley, PhD§,
  6. Yun Wang, MSc§,
  7. Hidar Mahdi, MD,
  8. Rouba Ali-Fehmi, MD,
  9. Robert T. Morris, MD*,
  10. Mohammed Elshaikh, MD# and
  11. Adnan R. Munkarah, MD§
  1. * From the Division of Gynecologic Oncology, Wayne State University, Detroit, MI;
  2. Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN;
  3. Division of Gynecologic Surgery, Washington University School of Medicine, St. Louis, MO;
  4. § Department of Women’s Health Services, Henry Ford Health Systems, Detroit, MI;
  5. Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH; and
  6. Department of Pathology, Wayne State University; and
  7. #Department of Radiation Oncology, Henry Ford Health Systems, Detroit, MI.
  1. Address correspondence and reprint requests to Zaid R Al-Wahab, MD, Wayne State University, 4160 John R, Suite 721, Detroit, MI 48201. E-mail: zalwahab{at}med.wayne.edu.

Abstract

Objective The aim of this study was to evaluate the impact of race on the overall survival (OS) and progression-free survival (PFS) of white and African-American patients with uterine clear cell carcinoma (UCCC).

Methods A retrospective review was conducted of all primary UCCC cases treated at 1 of 4 major gynecologic cancer centers between 1982 and 2012. Patients and tumor characteristics were retrieved from the cancer databases of the respective institutions and based on a retrospective review of the medical records. Differences in the OS and PFS between African-American and white women were compared using the Kaplan-Meier curves and log-rank test for univariate analysis. Cox regression models for the multivariate analyses were built to evaluate the relative impact of the various prognostic factors.

Results One hundred seventy women with UCCC were included in the study, including 118 white and 52 African-American women. Both groups were comparable with respect to age (P = 0.9), stage at diagnosis (P = 0.34), angiolymphatic invasion (P = 0.3), and depth of myometrial invasion (P = 0.84). In the multivariate analyses for known prognostic factors, OS and PFS were significantly different between white and African-American patients in the early-stage disease (hazard ratio [HR], 5.4; 95% confidence interval [CI], 1.2–23.2; P = 0.023 and HR, 3.5; 95% CI, 1.60–7.77; P = 0.0016, respectively) but not in the advanced-stage disease (HR, 0.83; 95% CI, 0.40–1.67; P = 0.61 and HR, 1.5; 95% CI, 0.84–2.78; P = 0.15, respectively).

Conclusions In the current study, African-American patients have a prognosis worse than that of white patients in early-stage UCCC. We could not prove the same difference in advanced-stage disease.

  • Racial disparities
  • Clear cell endometrial cancer
  • Uterine clear cell carcinoma
  • Clear cell carcinoma
  • African American
  • White
  • Race
  • Survival

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Footnotes

  • The authors declare no conflicts of interest.

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