Abstract
This study examined whether differences in survival for endometrial cancer attributed to race are primarily associated with socioeconomic status, comorbid illnesses, molecular genetic alterations, and other disease-related characteristics identified as poor prognostic factors. One hundred fifty-two surgically staged patients with endometrial cancer (37 African-American and 115 European-American women) treated from 1990 to 1994 were analyzed for differences in demographics, disease-related characteristics, and survival. Survival was poorer for African-American women than for European-American women. African-American women had lower socioeconomic status and a higher prevalence of poor prognostic factors. Surgical stage, positive peritoneal cytology, angiolymphatic invasion, cervical stromal involvement, and a history of other malignancies were similar between the two groups. The most important predictors of survival were age at diagnosis, surgical stage, myometrial invasion, positive peritoneal cytology, cervical stromal involvement, tumor grade, aneuploidy, histology, S-phase fraction, number of poor prognostic factors, and race. Racial differences in survival were not explained by socioeconomic status, comorbid illnesses, or estrogen use. When incorporating the number of poor prognostic factors in a survival model with race and surgical stage, race ceased to be of significant prognostic value. In an analysis restricted to women with poor prognostic factors, this phenomena also occurred after adjusting for the number of poor prognostic factors. These findings suggest that the cumulative number of poor prognostic factors, not race, is a more important predictor of survival in endometrial cancer.
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