title: Analysis of racial disparities in stage IIIC epithelial ovarian cancer care and outcomes in a tertiary gynecologic oncology referral center.
abstract: OBJECTIVE
  To examine disparities in delivery of care and survival according to racial classification among White and African-American women with Stage IIIC epithelial ovarian cancer undergoing initial treatment in a tertiary referral center setting.
  
  
  METHODS
  All consecutive patients diagnosed with Stage IIIC epithelial ovarian cancer between 1/1/95 and 12/31/08 were identified and clinic-pathologic variables retrospectively collected. Differences in initial treatment paradigm, surgical and adjuvant therapy, and overall survival according to racial classification were assessed by univariate and multivariate analyses.
  
  
  RESULTS
  A total of 405 patients (White, n=366; African-American, n=39) were identified. There were no significant differences according to racial classification in age, CA125, ASA class, histology, tumor grade, the frequency of initial surgery (90.4% vs 82.1%, p=0.06), optimal residual disease (73.0% vs 69.2%, p=0.28), no gross residual disease (51.4% vs 53.8%, p=0.49), and platinum-taxane chemotherapy (88.3% vs 87.2%, p=0.55). The median overall survival for White patients was 50.5 months (95%CI=43.2-57.9 months), compared to 47.0 (95%CI=36.2-57.8) months for African-Americans (p=0.57). On multivariate analysis, age, tumor grade 3, serum albumin <3.0 g/dl, platinum-based chemotherapy, and no gross residual disease were independently associated with overall survival, while African-American race was not (HR=1.06, 95%CI=0.61-1.79).
  
  
  CONCLUSIONS
  Among women undergoing initial treatment for ovarian cancer at a tertiary referral center, African-American patients were as likely as White patients to undergo cytoreductive surgery, be left with minimal post-surgical residual disease, and receive appropriate chemotherapy. With equal access to gynecologic oncology care and multidisciplinary cancer resources, the survival disparities according to race observed in population-based studies are largely mitigated.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, CA 92868, USA. rbristow@uci.edu
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Stefanie
authors.initials: S
authors.lastname: Ueda
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Gerardi
authors.forename: Onaopemipo B
authors.initials: OB
authors.lastname: Ajiboye
authors.forename: Okechukwu A
authors.initials: OA
authors.lastname: Ibeanu
mesh_terms: D001741:Black or African American; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000208:ethnology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D010051:Ovarian Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D012017:Referral and Consultation; D016896:Treatment Outcome; D044465:White People