Impact of Neoadjuvant Chemotherapy on Survival Outcome in Advanced Endometrial Cancer in Hispanic vs Non-Hispanic Women
Abstract
Introduction and Objective. Neoadjuvant chemotherapy, while not the first line treatment for advanced stage endometrial carcinoma (ASEC), is often a good option for patients in which optimal debulking cannot be achieved (1). However, Hispanic women have been shown to receive guideline driven treatment less frequently than their non-Hispanic counterparts (2). In addition, as the survivability of cancer increases, the disparity in survival rates increases between racial and ethnic minorities compared to the non-Hispanic population (3). In this study, using the National Cancer Database, we compared survival outcomes between Hispanic and non-Hispanic patients with advanced endometrial cancer receiving neoadjuvant chemotherapy. Methods. Our study was focused on those with ASEC (clinical FIGO III and IV) who underwent neoadjuvant chemotherapy followed by cytoreductive surgery with known ethnicity data. We divided them into two analytical arms: Hispanic and non-Hispanic. Chi-square analysis was used for exploratory data analysis comparing age, race, facility type, median income, insurance, comorbidity index, and FIGO stage between the two arms. Later, we performed a Kaplan-Meier survival analysis to analyze overall survival (OS) outcomes between the Hispanic and non-Hispanic arms. Results. Of the 53,693 individuals with ASEC, 4,864 met our criteria. The Hispanic arm and non-Hispanic arm comprised 369 (7.6%) and 4495 (92.4%) respectively. There are significant differences (p < 0.001) in demographic data between the Hispanic and non-Hispanic arms with respect to age, facility type, median income, and insurance status. Only 3.6% of the women in the non-Hispanic arm are uninsured while 14.4% of the Hispanic arm is uninsured, and Hispanic women are being diagnosed with late-stage endometrial carcinoma earlier with 49.6% of women being diagnosed before age 60 compared to 31.4% in the non-Hispanic arm. The median survival time was 40.4 months (95%CI, 31.4-49.5) in the Hispanic arm and 31.4 (95% CI, 30.1-32.7) in the non-Hispanic arm. Conclusions-Implications. In our study, we evaluated the survival outcomes of Hispanic vs non-Hispanic individuals with ASEC receiving neoadjuvant chemotherapy. We observed that there is a significant difference in survival outcomes. Based on the Kaplan-Meier survival analysis, Hispanic individuals have a more favorable survival outcome compared to non-Hispanic individuals.
Keywords
health disparities, endometrial cancer, Hispanic, neoadjuvant chemotherapy
Presentation Type
Oral Presentation
Impact of Neoadjuvant Chemotherapy on Survival Outcome in Advanced Endometrial Cancer in Hispanic vs Non-Hispanic Women
Introduction and Objective. Neoadjuvant chemotherapy, while not the first line treatment for advanced stage endometrial carcinoma (ASEC), is often a good option for patients in which optimal debulking cannot be achieved (1). However, Hispanic women have been shown to receive guideline driven treatment less frequently than their non-Hispanic counterparts (2). In addition, as the survivability of cancer increases, the disparity in survival rates increases between racial and ethnic minorities compared to the non-Hispanic population (3). In this study, using the National Cancer Database, we compared survival outcomes between Hispanic and non-Hispanic patients with advanced endometrial cancer receiving neoadjuvant chemotherapy. Methods. Our study was focused on those with ASEC (clinical FIGO III and IV) who underwent neoadjuvant chemotherapy followed by cytoreductive surgery with known ethnicity data. We divided them into two analytical arms: Hispanic and non-Hispanic. Chi-square analysis was used for exploratory data analysis comparing age, race, facility type, median income, insurance, comorbidity index, and FIGO stage between the two arms. Later, we performed a Kaplan-Meier survival analysis to analyze overall survival (OS) outcomes between the Hispanic and non-Hispanic arms. Results. Of the 53,693 individuals with ASEC, 4,864 met our criteria. The Hispanic arm and non-Hispanic arm comprised 369 (7.6%) and 4495 (92.4%) respectively. There are significant differences (p < 0.001) in demographic data between the Hispanic and non-Hispanic arms with respect to age, facility type, median income, and insurance status. Only 3.6% of the women in the non-Hispanic arm are uninsured while 14.4% of the Hispanic arm is uninsured, and Hispanic women are being diagnosed with late-stage endometrial carcinoma earlier with 49.6% of women being diagnosed before age 60 compared to 31.4% in the non-Hispanic arm. The median survival time was 40.4 months (95%CI, 31.4-49.5) in the Hispanic arm and 31.4 (95% CI, 30.1-32.7) in the non-Hispanic arm. Conclusions-Implications. In our study, we evaluated the survival outcomes of Hispanic vs non-Hispanic individuals with ASEC receiving neoadjuvant chemotherapy. We observed that there is a significant difference in survival outcomes. Based on the Kaplan-Meier survival analysis, Hispanic individuals have a more favorable survival outcome compared to non-Hispanic individuals.