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To determine whether Black race is associated with treatment and survival among women with low-risk endometrial cancer. Black and White women with Stage IA grade 1–2 endometrioid endometrial carcinoma diagnosed from 2010 to 2016 in the SEER 18 dataset were identified (n = 23,431), and clinical and socioeconomic attributes obtained. Five-year cancer-specific survival (CSS) and relative survival (RS) were calculated using SEER*Stat 8.3.9. Cox proportional hazards model was used to determine predictors of overall survival (OS) and CSS. There was a significantly higher proportion of Black women who did not have surgery compared to White women (3% vs 1%, respectively; p < 0.0001). Residing in the South, being insured with Medicaid, and residing in a county with low median income were also associated with non-receipt of surgery. Black women remained less likely to undergo hysterectomy on multivariable analysis (OR 0.44, 95% CI 0.32–0.60). Non-receipt of hysterectomy was predictive of decreased CSS (HR 0.14, 95% CI 0.09–0.21) and OS (HR 0.18, 95% 0.14–0.23) on adjusted analysis. Black race was also an independent predictor of increased cancer-specific death (HR 2.07, 95% CI 1.50–2.86) as well as death from any cause (HR 1.74, 95% CI 1.44–2.09) on adjusted analysis. Black women with low-risk endometrial cancer were less likely to undergo hysterectomy and experienced decreased survival relative to White women. Further investigation is warranted to better understand the socioeconomic, geographic, and biologic factors that influence this disparity. • Black race, low socioeconomic status, and residing in the South were associated with non-receipt of cancer-directed surgery. • Five-year cancer-specific and relative survival were lower for Black women compared to White women. • Black race and receipt of hysterectomy were independent predictors of decreased cancer-specific and overall survival. [ABSTRACT FROM AUTHOR]

To determine whether Black race is associated with treatment and outcomes among a favorable cohort with low-risk endometrial cancer. All Black and White women with Stage IA grade 1-2 endometrioid endometrial carcinoma diagnosed from 2010 to 2016 in the SEER 18 dataset were identified (n=23431), and clinical and socioeconomic attributes obtained. Five-year cancer-specific survival (CSS) and relative survival (RS) were calculated using SEER*Stat 8.3.8. Statistical analyses were performed with independent t-test, Chi-Square test, and Cox proportional hazard regression. Although the majority of patients underwent surgery, there was a significantly higher proportion of Black women who did not have surgery compared to White women (1% vs 3%, respectively; p<0.0001). Reasons for having not undergone surgery were similar between the two groups: not recommended, Blacks 74% vs Whites 75%; medically contraindicated, Blacks 16% vs Whites 9%; patient refusal, Blacks 16% vs Whites 10%; p=0.293. Black women were overrepresented in groups where more women did not undergo hysterectomy: women residing in the South (2.1% vs 1.3%, p=0.002) and those with Medicaid (3.4%) or no insurance (2.1%) compared to those with private insurance or Medicare (1.3%, p<0.0001). However, Black women remained less likely to undergo hysterectomy after adjusting for age, ethnicity, geography, grade, insurance status, and socioeconomic status (OR 0.379, p<0.0001). Five-year CSS was favorable in both groups, though significantly lower among Black women (CSS 95.0%, 95% CI 93.2-96.4%) compared to White women (CSS 97.8%, 95% CI 97.5-98.1%). A similar trend was noted for 5-year RS, with 95.4% for Black women (95% CI 92.2%-97.3%) versus 100% for White women. Black race was an independent predictor of increased cancer-specific death (HR 1.76, 95% CI 1.46-2.12) as well as all-cause mortality (HR 2.14, 95% CI 1.54-2.98) on adjusted analysis. We found that, even in a good prognostic group, Black women are less likely to undergo hysterectomy and have an increased risk of death among women with low-risk endometrial cancer. This bolsters prior work demonstrating that the association of race and poor outcomes is not only due to higher grade, more aggressive histologic type, and more advanced stage at diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: Endometrial cancer due to loss of mismatch repair proteins may be caused by epigenetic or genetic factors. Complete profiling is not routinely performed in clinical practice. We sought to explore outcomes of women with mismatch repair deficiency (MMRd) due to epigenetic MLH-1 promoter hypermethylation (MMRd-MLH). We hypothesize that MMRd-MLH correlates with worse clinical outcomes in endometrial cancer. Methods: Under an IRB protocol, we retrospectively identified patients with endometrioid endometrial adenocarcinoma undergoing hysterectomy at our institution from 2016-2020. These patients underwent routine immunohistochemical testing for MMRd, with subsequent genetic testing or methylation studies for loss of MMR proteins. We examined patient data in three cohorts: MMR proficient (MMRp), MMRd-MLH, and MMRd deficiency due to germline mutation (MMRd-G). We excluded patients who did not undergo MMR testing and those who were MMR deficient due to other causes. We examined clinical data via univariate and multivariate tests and Kaplan-Meier survival analyses. Results: We identified 327 patients who met the criteria for review. The majority (243, 74%) were MMRp, 74 (23%) were MMRd-MLH, and ten (3%) were MMRd-G. On univariate analysis, we observed no differences in the history of post-menopausal hormone replacement therapy, family history of cancer, personal history of hypertension or diabetes mellitus, or body mass index. We found that when compared to the other two groups, MMRd-MLH patients were more like to have grade 2-3 tumors (p < 0.01) and LVSI (p < 0.001). We identified statistically significant associations between age at surgery (60, 67, and 60 years, respectively) and depth of invasion (0.41cm, 0.67cm, and 0.18cm). We did not observe significant differences in the stage. We identified that MMRd-MLH was associated with pathologic high-intermediate risk factors leading to increased adjuvant therapy in stage I disease (p=0.04). We observed a 4.1% recurrence rate in MMRp compared to 8.1% in the MMRd-MLH group compared to no recurrences in MMRd-G (p = NS). When comparing MMRp and MMRd-MLH in Kaplan-Meier analyses, we observed a statistical difference in disease-free survival favoring those who were MMRp (p = 0.02). Median survival was not reached. There were no significant differences in overall survival between MMRp and MMRd-MLH. We did not identify independent prognostic factors for recurrence when controlling for age, stage, grade, or MMR status. [Display omitted] Conclusions: MMRd-MLH is associated with LVSI, higher grade, deeper tumor invasion, and a significantly higher rate of adjuvant therapy. We observed patients with MMRd-MLH were more likely to recur despite adjuvant therapy. MMRd-MLH may represent a poor prognostic factor and a target for further adjuvant therapy. [ABSTRACT FROM AUTHOR]