Racial and ethnic differences in early death among gynecologic malignancy - 26/07/24
Abstract |
Background |
Racial and ethnic differences in early death after cancer diagnosis have not been well studied in gynecologic malignancy.
Objective |
This study aimed to assess population-level trends and characteristics of early death among patients with gynecologic malignancy based on race and ethnicity in the United States.
Study Design |
The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program was queried to examine 461,300 patients with gynecologic malignancies from 2000 to 2020, including uterine (n=242,709), tubo-ovarian (n=119,989), cervical (n=68,768), vulvar (n=22,991), and vaginal (n=6843) cancers. Early death, defined as a mortality event within 2 months of the index cancer diagnosis, was evaluated per race and ethnicity.
Results |
At the cohort level, early death occurred in 21,569 patients (4.7%), including 10.5%, 5.5%, 2.9%, 2.5%, and 2.4% for tubo-ovarian, vaginal, cervical, uterine, and vulvar cancers, respectively (P<.001). In a race- and ethnicity-specific analysis, non-Hispanic Black patients with tubo-ovarian cancer had the highest early death rate (14.5%). Early death racial and ethnic differences were the largest in tubo-ovarian cancer (6.4% for Asian vs 14.5% for non-Hispanic Black), followed by uterine (1.6% for Asian vs 4.9% for non-Hispanic Black) and cervical (1.8% for Hispanic vs 3.8% to non-Hispanic Black) cancers (all, P<.001). In tubo-ovarian cancer, the early death rate decreased over time by 33% in non-Hispanic Black patients from 17.4% to 11.8% (adjusted odds ratio, 0.67; 95% confidence interval, 0.53–0.85) and 23% in non-Hispanic White patients from 12.3% to 9.5% (adjusted odds ratio, 0.77; 95% confidence interval, 0.71–0.85), respectively. The early death between-group difference diminished only modestly (12.3% vs 17.4% for 2000–2002 [adjusted odds ratio for non-Hispanic White vs non-Hispanic Black, 0.54; 95% confidence interval, 0.45–0.65] and 9.5% vs 11.8% for 2018–2020 [adjusted odds ratio, 0.65; 95% confidence interval, 0.54–0.78]).
Conclusion |
Overall, approximately 5% of patients with gynecologic malignancy died within the first 2 months from cancer diagnosis, and the early death rate exceeded 10% in non-Hispanic Black individuals with tubo-ovarian cancer. Although improving early death rates is encouraging, the difference among racial and ethnic groups remains significant, calling for further evaluation.
Le texte complet de cet article est disponible en PDF.Key words : cervical cancer, early death, ethnicity, gynecologic malignancy, ovarian cancer, race, uterine cancer
Plan
| This study was presented at the 2023 Congress of European Society of Gynecologic Oncology, Istanbul, Turkey, September 28, 2023, to October 1, 2023. |
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| All authors were unrelated to the work: consultant, research grant, Merck, royalties, and UpToDate (J.D.W.); consultant, Cardiff Oncology, Nutcracker, and participation in the Steering Committee for the Global Coalition of Adaptive Research (L.D.R.); consultation, AstraZeneca, CooperSurgical, and KLS Martin (M.K.); and none for others. |
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| This study received funding from the Ensign Endowment for Gynecologic Cancer Research (K.M.). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. |
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| This study was exempt by the University of Southern California Institutional Review Board (trial number: HS-16-00481). |
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| The data on which this study is based are publicly available on request at the National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Result (SEER) Program (seer.cancer.gov/). |
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| The manuscript’s corresponding author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. The NCI’s SEER Program is the source of the deidentified data used; race and ethnicity were grouped by the program; and the program has not verified and is not responsible for the statistical validity of the data analysis or the conclusions derived by the study team. |
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| Cite this article as: Lee MW, Vallejo A, Furey KB, et al. Racial and ethnic differences in early death among gynecologic malignancy. Am J Obstet Gynecol 2024;231:231.e1-11. |
Vol 231 - N° 2
P. 231.e1-231.e11 - août 2024 Retour au numéro
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