title: The impact of race on outcomes of patients with early stage uterine endometrioid carcinoma.
abstract: OBJECTIVE
  The purpose of the present study was to determine whether racial disparity exists between African American (AA) and non-African American (NAA) patients with uterine endometrioid carcinoma who received similar multidisciplinary management.
  
  
  METHODS
  We identified 766 patients with endometrioid adenocarcinoma 2009 FIGO stages I-II who underwent hysterectomy. Patients were divided into two groups; AA and NAA. Recurrence-free survival (RFS), disease specific survival (DSS) and overall survival (OS) for two groups were calculated.
  
  
  RESULTS
  Median follow-up was 5.1 years. 27% were AA and 73% were NAA. All patients underwent hysterectomy and oophorectomy. 80% had peritoneal cytology examination and 69% underwent lymphadenectomy. AA patients were more likely to have higher grade tumors, and higher incidence of lymphovascular space involvement (LVSI). Although the two groups were balanced with regards to surgical staging and adjuvant treatment received, the 5-year RFS and DSS were significantly lower in AA compared to NAA patients (91% vs 84%, p=0.030; 95% vs 88%, p=0.011, respectively). Overall survival was not significantly different between the two groups. On multivariate analysis, after adjusting for other prognostic factors, race (AA vs NAA) was not a significant predictor of outcome. Grade 3 tumors and the presence of LVSI were the only two independent predictors of RFS and DSS with p ≤ 0.001 and p ≤ 0.001, respectively.
  
  
  CONCLUSIONS
  In this large hospital-based study, AA race was associated with a higher incidence of adverse pathological features and worse recurrence-free and disease-specific survival. However, on multivariate analysis race was not an independent prognostic factor. Further studies are needed to elucidate possible underlying molecular mechanisms for these poorer outcomes.
authors.affiliation: Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI 48202, USA. melshai1@hfhs.org
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elshaikh
authors.forename: Adnan R
authors.initials: AR
authors.lastname: Munkarah
authors.forename: Jared R
authors.initials: JR
authors.lastname: Robbins
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Laser
authors.forename: Neil
authors.initials: N
authors.lastname: Bhatt
authors.forename: Chad
authors.initials: C
authors.lastname: Cogan
authors.forename: Farzan
authors.initials: F
authors.lastname: Siddiqui
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000208:ethnology* / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000208:ethnology* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult