Racial disparities in survival among patients with germ cell tumors of the ovary--United States.
OBJECTIVE
To compare the survival of African American (AA) and white (W) patients with malignant germ cell tumors of the ovary (OGCT).


METHODS
Patients with a diagnosis of OGCT were identified from Surveillance, Epidemiology, and End Results Program (SEER) from 1988 to 2004, and were divided into African American (AA) and white (W) subgroups. Only surgically treated patients were included. Histology was grouped into dysgerminoma (D), malignant teratoma (MT), and mixed germ cell tumors with pure non-dysgerminoma cell tumors (MGCT/PNDCT). Statistical analysis using Chi-square, Fisher's Exact Test, Kaplan-Meier survival methods, and Cox regression proportional hazards were performed.


RESULTS
In 1110 patients with OGCT, 970 (87.4%) were W and 140 (12.6%) were AA. MGCT/PNDCT histology was equally represented in AA and W. However, W were twice as likely to present with D (W 34% vs. AA 16%, p<0.01) and 1.5 times less likely to present with MT (W 41% vs. AA 59%, p<0.01). The majority (W 64%, AA 64%) of OGCT were stage I. Advanced stage (FIGO III and IV) tumors were more prominent in AA (24% vs. 18%, p>0.05). Complete surgical staging effort was utilized more frequently in W (49%) as compared to AA (38%; p=0.001). Overall 5-year survival was 92% for W and 86% for AA (p=0.02). In multivariate analysis race was not an independent predictor of survival when histology, stage and surgical staging were controlled.


CONCLUSIONS
In our study, a higher prevalence of complete surgical staging and a favorable distribution of low risk histologic types may explain the improved survival observed in white patients with OGCT. However, race was not an independent predictor of survival.
Bryant
Christopher S
CS
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Wayne State University School of Medicine, Detroit, MI, USA. csbryant@med.wayne.edu
Kumar
Sanjeev
S
Shah
Jay P
JP
Mahdi
Haider
H
Ali-Fehmi
Rouba
R
Munkarah
Adnan R
AR
Deppe
Gunter
G
Morris
Robert T
RT
D000293:Adolescent; D000328:Adult; D044383:Black People; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D044465:White People; D055815:Young Adult; D001741:Black or African American