title: Racial disparities in survival in malignant germ cell tumors of the ovary.
abstract: OBJECTIVE
  To investigate racial disparities with respect to adjuvant treatment and survival in patients presenting with malignant ovarian germ cell tumors (OGCT).
  
  
  METHODS
  The National Cancer Database (NCDB) was used to identify women diagnosed with OGCT. Demographic data were abstracted, including stratification by race and histology. Standard univariate and multivariate analyses using logistic regression were performed to describe predictors of adjuvant treatment. Kaplan-Meier and Cox proportional hazards survival methods were used to evaluate racial differences in survival between African American (AA) and white (W) women.
  
  
  RESULTS
  The study population included 2196 patients, with 1654 (75.3%) W and 328 (14.9%) AA women. Histologic distribution varied significantly by race (p<0.0001), but neither age nor stage at presentation showed racial differences (p=0.086 and p=0.209, respectively). AA received more chemotherapy than W (W: 54.6%, AA: 65.5%, p=0.008), but in multivariate analysis there was no statistically significant difference in any adjuvant treatment modality. Despite similar treatment, and independent of histology, survival varied significantly by race with 91% (CI 0.89-0.93) five year survival in W patients compared to 84% five year survival in AA (CI 0.8-0.89) (p=0.02). These disparities were most pronounced in advanced stage disease, with 5 year survival of 84% (CI 0.79-0.89) in W compared to 61% (CI 0.48-0.78) for AA in stage III (p=0.0002), and 54% (CI 0.42-0.68) compared to 14% (CI 0.03-0.71) for stage IV (p=0.05).
  
  
  CONCLUSIONS
  AA with OGCT have significantly worse 5 year survival when compared to W patients despite similar rates and modalities of adjuvant treatment.
authors.affiliation: Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States. Electronic address: ehinchcliff@partners.org.
authors.forename: Emily
authors.initials: E
authors.lastname: Hinchcliff
authors.affiliation: Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
authors.forename: J Alejandro
authors.initials: JA
authors.lastname: Rauh-Hain
authors.affiliation: Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States.
authors.forename: Joel T
authors.initials: JT
authors.lastname: Clemmer
authors.affiliation: Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Diver
authors.affiliation: Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
authors.forename: Tracilyn
authors.initials: T
authors.lastname: Hall
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stall
authors.affiliation: Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
authors.forename: Whitfield
authors.initials: W
authors.lastname: Growdon
authors.affiliation: Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
authors.forename: Rachel
authors.initials: R
authors.lastname: Clark
authors.affiliation: Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
authors.forename: John
authors.initials: J
authors.lastname: Schorge
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000208:ethnology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Ovarian cancer; Ovarian germ cell tumors; Racial disparities; Rare tumors