title: Endometrial cancer in morbidly obese women: do racial disparities affect surgical or survival outcomes?
abstract: OBJECTIVE
  Endometrial cancer mortality disproportionately affects black women and whether greater prevalence of obesity plays a role in this disparity is unknown. We examine the effect of race on post-surgical complications, length of stay, and mortality specifically in a morbidly obese population.
  
  
  METHODS
  Black and white women with endometrial cancer diagnosed from 1996 to 2012 were identified from the University Pathology Group database in Detroit, Michigan, and records were retrospectively reviewed to obtain clinicopathological, demographic, and surgical information. Analysis was limited to those with a body mass index of 40kg/m(2) or greater. Differences in the distribution of variables by race were assessed by chi-squared tests and t-tests. Kaplan-Meier and Cox regression analyses were performed to examine factors associated with mortality.
  
  
  RESULTS
  97 white and 89 black morbidly obese women were included in this analysis. Black women were more likely to have type II tumors (33.7% versus 15.5% of white women, p-value=0.003). Hypertension was more prevalent in black women (76.4% versus 58.8%, p-value=0.009), and they had longer hospital stays after surgery despite similar rates of open vs minimally invasive procedures and lymph node dissection (mean days=5.4) compared to whites (mean days=3.5, p-value=0.036). Wound infection was the most common complication (16.5% in whites and 14.4% in blacks, p-value=0.888). Blacks were more likely to suffer other complications, but overall the proportions did not differ by race. In univariate analyses, black women had higher risk of endometrial cancer-related death (p-value=0.090). No racial differences were noted in adjusted survival analyses.
  
  
  CONCLUSIONS
  A more complete investigation, incorporating socio-demographic factors, is warranted to understand the effects of morbid obesity and race on endometrial cancer.
authors.affiliation: Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA; Karmanos Cancer Institute, Population Studies and Disparities Program, Detroit, MI, USA. Electronic address: cotem@karmanos.org.
authors.forename: M L
authors.initials: ML
authors.lastname: Cote
authors.affiliation: Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Ruterbusch
authors.affiliation: Wayne State University School of Medicine, Department of Pathology, Detroit, MI, USA.
authors.forename: Q
authors.initials: Q
authors.lastname: Ahmed
authors.affiliation: Wayne State University School of Medicine, Department of Pathology, Detroit, MI, USA.
authors.forename: S
authors.initials: S
authors.lastname: Bandyopadhyay
authors.affiliation: Wayne State University School of Medicine, Department of Pathology, Detroit, MI, USA.
authors.forename: B
authors.initials: B
authors.lastname: Alosh
authors.affiliation: Wayne State University School of Medicine, Department of Pathology, Detroit, MI, USA.
authors.forename: E
authors.initials: E
authors.lastname: Abdulfatah
authors.affiliation: Wayne State University School of Medicine, Department of Gynecologic Oncology, Detroit, MI, USA; Karmanos Cancer Institute, Department of Gynecologic Oncology, Detroit, MI, USA.
authors.forename: S
authors.initials: S
authors.lastname: Seward
authors.affiliation: Wayne State University School of Medicine, Department of Gynecologic Oncology, Detroit, MI, USA; Karmanos Cancer Institute, Department of Gynecologic Oncology, Detroit, MI, USA.
authors.forename: R
authors.initials: R
authors.lastname: Morris
authors.affiliation: Wayne State University School of Medicine, Department of Pathology, Detroit, MI, USA.
authors.forename: R
authors.initials: R
authors.lastname: Ali-Fehmi
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000208:ethnology / Q000401:mortality / Q000601:surgery; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D002277:Carcinoma / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D018269:Carcinoma, Endometrioid / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D009767:Obesity, Morbid / Q000208:ethnology*; D011183:Postoperative Complications / Q000208:ethnology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000208:ethnology; D016019:Survival Analysis; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Endometrial carcinoma; Morbid obesity; Race/ethnicity