TY - JOUR
T1 - The Hispanic Paradox in endometrial cancer
T2 - A National Cancer Database study
AU - Malagon-Blackwell, Erica M.
AU - Seagle, Brandon Luke L.
AU - Nieves-Neira, Wilberto
AU - Shahabi, Shohreh
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Objective To compare the overall survival of non-Hispanic white and Hispanic women with endometrial cancer. Methods We performed an observational retrospective cohort study of Hispanic and non-Hispanic women with endometrial cancer from the 2004–2014 National Cancer Database. Baseline characteristics were compared with the Chi-squared test for categorical variables or the Mann-Whitney U test for ordinal or continuous variables. The Kaplan-Meier method was used to estimate unadjusted survival times, which were compared with the log-rank test. Missing data was imputed using multiple imputation with chained equations. A multivariable parametric accelerated failure time model for survival was used. Sensitivity analyses were performed using matched cohort analyses of the overall cohort, and of subgroups based on stage or type. Results 112,574 non-Hispanic and 6313 Hispanic women met inclusion criteria. Five-year survival was slightly higher for Hispanic women (83.1% (82.1–84.3%) versus 81.4% (81.2–81.7%), P = 0.002). Hispanic women were younger, treated at lower volume hospitals, and more often diagnosed with a type II histology and stage II–IV disease compared to non-Hispanic women (all P < 0.001). With multivariable adjustment for measured confounders, Hispanic women lived 8% longer than non-Hispanic women (time-ratio (95% CI) 1.08 (1.02–1.14), P = 0.01). When bias-reducing matched cohort analyses were used for sensitivity analyses, Hispanic women did not have significantly different survival than non-Hispanic women. Conclusion Hispanic ethnicity was not associated with a clinically meaningful difference in survival among women with endometrial cancer.
AB - Objective To compare the overall survival of non-Hispanic white and Hispanic women with endometrial cancer. Methods We performed an observational retrospective cohort study of Hispanic and non-Hispanic women with endometrial cancer from the 2004–2014 National Cancer Database. Baseline characteristics were compared with the Chi-squared test for categorical variables or the Mann-Whitney U test for ordinal or continuous variables. The Kaplan-Meier method was used to estimate unadjusted survival times, which were compared with the log-rank test. Missing data was imputed using multiple imputation with chained equations. A multivariable parametric accelerated failure time model for survival was used. Sensitivity analyses were performed using matched cohort analyses of the overall cohort, and of subgroups based on stage or type. Results 112,574 non-Hispanic and 6313 Hispanic women met inclusion criteria. Five-year survival was slightly higher for Hispanic women (83.1% (82.1–84.3%) versus 81.4% (81.2–81.7%), P = 0.002). Hispanic women were younger, treated at lower volume hospitals, and more often diagnosed with a type II histology and stage II–IV disease compared to non-Hispanic women (all P < 0.001). With multivariable adjustment for measured confounders, Hispanic women lived 8% longer than non-Hispanic women (time-ratio (95% CI) 1.08 (1.02–1.14), P = 0.01). When bias-reducing matched cohort analyses were used for sensitivity analyses, Hispanic women did not have significantly different survival than non-Hispanic women. Conclusion Hispanic ethnicity was not associated with a clinically meaningful difference in survival among women with endometrial cancer.
KW - Endometrial cancer
KW - Ethnicity
KW - Hispanic
KW - Prognosis
KW - Race
KW - Survival
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U2 - 10.1016/j.ygyno.2017.05.026
DO - 10.1016/j.ygyno.2017.05.026
M3 - Article
C2 - 28549815
AN - SCOPUS:85019549060
SN - 0090-8258
VL - 146
SP - 351
EP - 358
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 2
ER -