title: Black race independently predicts worse survival in uterine carcinosarcoma.
abstract: OBJECTIVE
  GOG 150 suggested that Black women had worse survival compared to White women with uterine carcinosarcoma. Our objective was to compare treatment and survival outcomes between Black and White women at a National Comprehensive Cancer Network (NCCN) cancer center serving a diverse racial population.
  
  
  METHODS
  An IRB approved retrospective cohort study of uterine carcinosarcoma patients diagnosed between 2000 and 2012 was performed. Survival was compared by race and stratified by stage. Median progression free and overall survival (PFS and OS) were calculated using Kaplan-Meier estimates and compared with the log-rank test. Multivariate survival analysis was performed with Cox proportional hazards model.
  
  
  RESULTS
  158 women were included: 93 (59%) were Black and 65 (41%) were White. 95 (60%) had early stage disease and 63 (40%) had advanced stage disease. Black women had a shorter PFS (7.9 vs. 14.2 months, p<0.001) and OS (13.4 vs. 30.8 months, p<0.001). There was no difference in survival between Black and White women with advanced stage disease (OS 8.5 vs. 11.8, p=0.18). However, PFS and OS were worse in Black women compared to White women with early stage disease (PFS 13.6 vs. 77.4, p=0.001), (OS 25.4 vs. 94.7, p=0.003). On multivariate analysis accounting for age, stage, BMI, and adjuvant treatment, Black race remained independently associated with risk of death (HR 2.0; 95% CI 1.25-3.23).
  
  
  CONCLUSIONS
  Black women with uterine carcinosarcoma have worse survival compared to White women despite similar patient and treatment characteristics. This difference is largely due to differences in survival in early stage disease.
authors.affiliation: University of Alabama at Birmingham Division of Gynecologic Oncology, USA. Electronic address: britte@uab.edu.
authors.forename: Britt K
authors.initials: BK
authors.lastname: Erickson
authors.affiliation: University of Colorado Department of Obstetrics and Gynecology, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Doo
authors.affiliation: Cincinnati Children's Hospital Medical Center Division of Biostatistics and Epidemiology, USA.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: University of Alabama at Birmingham Division of Gynecologic Oncology, USA.
authors.forename: Warner K
authors.initials: WK
authors.lastname: Huh
authors.affiliation: University of Alabama at Birmingham Division of Gynecologic Oncology, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Leath
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D002173:Cancer Care Facilities; D002296:Carcinosarcoma / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008875:Middle Aged; D015999:Multivariate Analysis; D018365:Neoplasm, Residual; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D044465:White People / Q000706:statistics & numerical data*
keywords: Adjuvant treatment; Racial disparities; Uterine carcinosarcoma