Racial Differences in Survival From Epithelial Ovarian Cancer Are Associated With Stage at Diagnosis and Use of Neoadjuvant Therapy: A 10-Year Single-Institution Experience With a Racially Diverse Urban Population

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Abstract

Objective: The aim of this study was to evaluate the racial/ethnic disparities in ovarian cancer survival in a diverse population. Methods: We performed a retrospective cohort study evaluating all patients with epithelial ovarian cancer who received primary treatment at Montefiore Medical Center from 2005 to 2015. Clinicopathologic and survival data were abstracted from medical records. Two-sided statistical analyses were performed using SAS 9.3. Results: Three hundred forty-four evaluable patients were identified: 85 (25%) black, 107 (31%) white, 74 (21%) Hispanic, and 78 (23%) other. Black patients were more likely to present with stage IV disease (P = 0.01) and receive neoadjuvant chemotherapy (P < 0.01). By Kaplan-Meier survival analysis, black race was associated with worse recurrence-free survival (P = 0.01) when compared with white race. In multivariate Cox regression model including treatment and stage, race was no longer associated with survival. In a separate multivariate analysis, utilization of neoadjuvant chemotherapy was associated with black race (odds ratio 4.03; 95% confidence interval, 1.56-10.38; P < 0.01) and stage IV disease (odds ratio 3.44; 95% confidence interval, 1.66-7.12; P < 0.01). Conclusions: In a racially/ethnically diverse population with ovarian cancer, black women had poorer disease-free survival than whites, although this was statistically accounted for by stage at diagnosis and use of neoadjuvant therapy. Research is needed to determine how differences in access/utilization of care and genetic differences in tumor biology may impact late stage diagnosis and use of neoadjuvant chemotherapy among black ovarian cancer patients.

Original languageEnglish (US)
Pages (from-to)749-756
Number of pages8
JournalInternational Journal of Gynecological Cancer
Volume28
Issue number4
DOIs
StatePublished - May 1 2018

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Neoadjuvant Therapy
Urban Population
antineoplaston A10
Ovarian Neoplasms
Survival
Drug Therapy
Odds Ratio
Confidence Intervals
Delayed Diagnosis
Kaplan-Meier Estimate
Survival Analysis
Hispanic Americans
Proportional Hazards Models
Population
Disease-Free Survival
Medical Records
Cohort Studies
Multivariate Analysis
Retrospective Studies
Recurrence

Keywords

  • Neoadjuvant chemotherapy
  • Ovarian cancer
  • Racial disparity
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

@article{62162017d9f5412598b4f88dae961279,
title = "Racial Differences in Survival From Epithelial Ovarian Cancer Are Associated With Stage at Diagnosis and Use of Neoadjuvant Therapy: A 10-Year Single-Institution Experience With a Racially Diverse Urban Population",
abstract = "Objective: The aim of this study was to evaluate the racial/ethnic disparities in ovarian cancer survival in a diverse population. Methods: We performed a retrospective cohort study evaluating all patients with epithelial ovarian cancer who received primary treatment at Montefiore Medical Center from 2005 to 2015. Clinicopathologic and survival data were abstracted from medical records. Two-sided statistical analyses were performed using SAS 9.3. Results: Three hundred forty-four evaluable patients were identified: 85 (25{\%}) black, 107 (31{\%}) white, 74 (21{\%}) Hispanic, and 78 (23{\%}) other. Black patients were more likely to present with stage IV disease (P = 0.01) and receive neoadjuvant chemotherapy (P < 0.01). By Kaplan-Meier survival analysis, black race was associated with worse recurrence-free survival (P = 0.01) when compared with white race. In multivariate Cox regression model including treatment and stage, race was no longer associated with survival. In a separate multivariate analysis, utilization of neoadjuvant chemotherapy was associated with black race (odds ratio 4.03; 95{\%} confidence interval, 1.56-10.38; P < 0.01) and stage IV disease (odds ratio 3.44; 95{\%} confidence interval, 1.66-7.12; P < 0.01). Conclusions: In a racially/ethnically diverse population with ovarian cancer, black women had poorer disease-free survival than whites, although this was statistically accounted for by stage at diagnosis and use of neoadjuvant therapy. Research is needed to determine how differences in access/utilization of care and genetic differences in tumor biology may impact late stage diagnosis and use of neoadjuvant chemotherapy among black ovarian cancer patients.",
keywords = "Neoadjuvant chemotherapy, Ovarian cancer, Racial disparity, Survival",
author = "Miller, {Eirwen M.} and Joan Tymon-Rosario and Howard Strickler and Xianhong Xie and Xue, {Xiaonan (Nan)} and Kuo, {Dennis Yi-Shin} and Makhija, {Sharmila K.} and Nevadunsky, {Nicole S.}",
year = "2018",
month = "5",
day = "1",
doi = "10.1097/IGC.0000000000001238",
language = "English (US)",
volume = "28",
pages = "749--756",
journal = "International Journal of Gynecological Cancer",
issn = "1048-891X",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Racial Differences in Survival From Epithelial Ovarian Cancer Are Associated With Stage at Diagnosis and Use of Neoadjuvant Therapy

T2 - A 10-Year Single-Institution Experience With a Racially Diverse Urban Population

AU - Miller, Eirwen M.

AU - Tymon-Rosario, Joan

AU - Strickler, Howard

AU - Xie, Xianhong

AU - Xue, Xiaonan (Nan)

AU - Kuo, Dennis Yi-Shin

AU - Makhija, Sharmila K.

AU - Nevadunsky, Nicole S.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Objective: The aim of this study was to evaluate the racial/ethnic disparities in ovarian cancer survival in a diverse population. Methods: We performed a retrospective cohort study evaluating all patients with epithelial ovarian cancer who received primary treatment at Montefiore Medical Center from 2005 to 2015. Clinicopathologic and survival data were abstracted from medical records. Two-sided statistical analyses were performed using SAS 9.3. Results: Three hundred forty-four evaluable patients were identified: 85 (25%) black, 107 (31%) white, 74 (21%) Hispanic, and 78 (23%) other. Black patients were more likely to present with stage IV disease (P = 0.01) and receive neoadjuvant chemotherapy (P < 0.01). By Kaplan-Meier survival analysis, black race was associated with worse recurrence-free survival (P = 0.01) when compared with white race. In multivariate Cox regression model including treatment and stage, race was no longer associated with survival. In a separate multivariate analysis, utilization of neoadjuvant chemotherapy was associated with black race (odds ratio 4.03; 95% confidence interval, 1.56-10.38; P < 0.01) and stage IV disease (odds ratio 3.44; 95% confidence interval, 1.66-7.12; P < 0.01). Conclusions: In a racially/ethnically diverse population with ovarian cancer, black women had poorer disease-free survival than whites, although this was statistically accounted for by stage at diagnosis and use of neoadjuvant therapy. Research is needed to determine how differences in access/utilization of care and genetic differences in tumor biology may impact late stage diagnosis and use of neoadjuvant chemotherapy among black ovarian cancer patients.

AB - Objective: The aim of this study was to evaluate the racial/ethnic disparities in ovarian cancer survival in a diverse population. Methods: We performed a retrospective cohort study evaluating all patients with epithelial ovarian cancer who received primary treatment at Montefiore Medical Center from 2005 to 2015. Clinicopathologic and survival data were abstracted from medical records. Two-sided statistical analyses were performed using SAS 9.3. Results: Three hundred forty-four evaluable patients were identified: 85 (25%) black, 107 (31%) white, 74 (21%) Hispanic, and 78 (23%) other. Black patients were more likely to present with stage IV disease (P = 0.01) and receive neoadjuvant chemotherapy (P < 0.01). By Kaplan-Meier survival analysis, black race was associated with worse recurrence-free survival (P = 0.01) when compared with white race. In multivariate Cox regression model including treatment and stage, race was no longer associated with survival. In a separate multivariate analysis, utilization of neoadjuvant chemotherapy was associated with black race (odds ratio 4.03; 95% confidence interval, 1.56-10.38; P < 0.01) and stage IV disease (odds ratio 3.44; 95% confidence interval, 1.66-7.12; P < 0.01). Conclusions: In a racially/ethnically diverse population with ovarian cancer, black women had poorer disease-free survival than whites, although this was statistically accounted for by stage at diagnosis and use of neoadjuvant therapy. Research is needed to determine how differences in access/utilization of care and genetic differences in tumor biology may impact late stage diagnosis and use of neoadjuvant chemotherapy among black ovarian cancer patients.

KW - Neoadjuvant chemotherapy

KW - Ovarian cancer

KW - Racial disparity

KW - Survival

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U2 - 10.1097/IGC.0000000000001238

DO - 10.1097/IGC.0000000000001238

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JO - International Journal of Gynecological Cancer

JF - International Journal of Gynecological Cancer

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