Objective: To report the impact of race on clinical outcomes in patients with stage IIIC endometrial carcinoma. Materials and Methods: A retrospective multi-institutional study included 90 black and 568 non-black patients with stage IIIC endometrial carcinoma who received adjuvant chemotherapy and radiation treatments. Overall survival (OS) and recurrence-free survival (RFS) were calculated by the Kaplan-Meier method. Propensity score matching (PSM) was conducted. Statistical analyses were conducted using SPSS version 27. Results: The Median follow-up was 45.3 months. black patients were significantly older, had more nonendometrioid histology, grade 3 tumors, and were more likely to have >1 positive paraaortic lymph nodes compared with non-black patients (all P <0.0001). The 5-year estimated OS and RFS rates were 45% and 47% compared with 77% and 68% for black patients versus non-black patients, respectively (P <0.001). After PSM, the 2 groups were well-balanced for all prognostic covariates. The estimated hazard ratios of black versus non-black patients were 1.613 (P value=0.045) for OS and 1.487 (P value=0.116) for RFS. After PSM, black patients were more likely to receive the “Sandwich” approach and concurrent chemoradiotherapy compared with non-black (P=0.013) patients. Conclusions: Black patients have higher rates of nonendometrioid histology, grade 3 tumors, and number of involved paraaortic lymph nodes, worse OS, and RFS, and were more likely to receive the “Sandwich” approach compared with non-black patients. After PSM, black patients had worse OS with a nonsignificant trend in RFS. Access to care, equitable inclusion on randomized trials, and identification of genomic differences are warranted to help mitigate disparities.

Objective: To examine the impact of the Affordable Care Act (ACA) on insurance rates among women diagnosed with a gynecologic malignancy comparing differences based on race and socioeconomic status.

Objective: Utilizing the National Cancer Data Base (NCDB), we explored prognostic indicators and optimal treatment modalities in vulvar melanoma.

Objectives: To determine trends in national patterns of care for advanced-stage uterine cancer, with attention to combinations of chemotherapy (CT) and radiation therapy (RT), and correlating with survival outcomes.Methods: The National Cancer Data Base (NCDB) was queried for women with surgical stage IIIC1 and IIIC2 uterine cancer diagnosed between 1998 and 2012. Treatment modality was categorized as RT alone, CT alone, RT then CT, CT then RT (including "sandwich" regimens), or concurrent CT-RT. Covariates were captured including facility type, disease stage (IIIC1 or IIIC2), race, age, insurance, income, education, histology, and era of treatment (1998–2006 and 2007–2012, corresponding to the publication of Gynecologic Oncology Group [GOG] 122 results), and tested for differences in treatment modality via the Χ2 test. Survival was compared among treatment modalities using Cox proportional-hazards regression while adjusting for covariates.Results: A total of 4,137 women met the inclusion criteria: 3,103 had complete data for inclusion into multivariate survival models. Of these, 1,865 received RT alone, 820 CT alone, 409 RT then CT, 886 CT then RT, and 157 concurrent CT-RT. The use of RT alone declined dramatically after 2006 (62.6% before, 12% after, P < .001), with the most common modalities after 2006 being CT then RT (43.9%) and CT alone (33.0%). Academic programs and comprehensive community programs were less likely to use RT alone (43.5% and 44.9%) than community programs (56.9%), and more likely to use CT alone (22.0% academic programs, 18.9% comprehensive community programs, 12.4% community programs) (P < .001). Stage IIIC2 disease was more likely than stage IIIC1 to be treated with CT alone (38%) or CT then RT (42%); stage IIIC1 was most frequently treated with RT alone (50.1%), (P < .001). In multivariate survival modeling, both CT alone and RT alone were associated with worse survival than any combination therapy (HR 0.87, P = .036). In patients treated after 2007, CT then RT was superior to CT alone (HR 2.3, 95% CI 1.5–3.5), however other pairwise treatment comparisons were not significant (Fig. 1). Objectives: To determine trends in national patterns of care for advanced-stage uterine cancer, with attention to combinations of chemotherapy (CT) and radiation therapy (RT), and correlating with survival outcomes. Methods: The National Cancer Data Base (NCDB) was queried for women with surgical stage IIIC1 and IIIC2 uterine cancer diagnosed between 1998 and 2012. Treatment modality was categorized as RT alone, CT alone, RT then CT, CT then RT (including "sandwich" regimens), or concurrent CT-RT. Covariates were captured including facility type, disease stage (IIIC1 or IIIC2), race, age, insurance, income, education, histology, and era of treatment (1998–2006 and 2007–2012, corresponding to the publication of Gynecologic Oncology Group [GOG] 122 results), and tested for differences in treatment modality via the Χ2 test. Survival was compared among treatment modalities using Cox proportional-hazards regression while adjusting for covariates. Results: A total of 4,137 women met the inclusion criteria: 3,103 had complete data for inclusion into multivariate survival models. Of these, 1,865 received RT alone, 820 CT alone, 409 RT then CT, 886 CT then RT, and 157 concurrent CT-RT. The use of RT alone declined dramatically after 2006 (62.6% before, 12% after, P < .001), with the most common modalities after 2006 being CT then RT (43.9%) and CT alone (33.0%). Academic programs and comprehensive community programs were less likely to use RT alone (43.5% and 44.9%) than community programs (56.9%), and more likely to use CT alone (22.0% academic programs, 18.9% comprehensive community programs, 12.4% community programs) (P < .001). Stage IIIC2 disease was more likely than stage IIIC1 to be treated with CT alone (38%) or CT then RT (42%); stage IIIC1 was most frequently treated with RT alone (50.1%), (P < .001). In multivariate survival modeling, both CT alone and RT alone were associated with worse survival than any combination therapy (HR 0.87, P = .036). In patients treated after 2007, CT then RT was superior to CT alone (HR 2.3, 95% CI 1.5–3.5), however other pairwise treatment comparisons were not significant (Fig. 1).

Objectives: To compare outcomes and national practice patterns in the treatment of ovarian carcinosarcoma (OCS) versus high-grade serous ovarian carcinoma (HGSOC). Methods: The National Cancer Data Base (NCDB) was reviewed to identify adult women diagnosed with OCS or HGSOC between 1998 and 2012. Demographic and clinical data were compared, and the impact of histology on overall survival (OS) was analyzed using the Kaplan-Meier method. The following tests were used: log-rank test to compare survival distributions, Wilcoxon rank-sum tests for continuous variables, and Χ2tests for categorical variables. Multivariate Cox proportional hazard modeling was used to examine differences in OS based on age, stage, race, insurance status, and type of cancer program at which care was received. Results: A total of 76,369 women met the inclusion criteria; 59,983 had complete data for inclusion in multivariate survival models. Of these, 1,450 (1.90%) were diagnosed with OCS, and 74,919 (98.1%) with HGSOC. Patients with OCS were more likely to be older (median age 68 vs 63 years, P < .0001), African-American (9.1% vs 6.3%, P < .0001), diagnosed with earlier-stage disease (stage I/II 26% vs 17%, P < .0001), and treated with radiation (3.0% vs 0.7%, P < .0001). They also had a higher 30-day and 90 day mortality after surgery (6.4% vs 2.4%, and 14.3% vs 5.3% respectively, both P < .0001) despite no significant difference in Charlson morbidity score (≥1, 19.9% vs 17.8%, P = .08). Women with OCS had compromised OS rates compared with HGSOC; this difference persisted when comparing 3-year survival for early-stage (OCS 57.2%, 95% CI 50.4%–64.9% vs HGSOC 84.4%, 95% CI 83.7%–85.2%) and late-stage disease (OCS 24.9%, 95% CI 21.4%–29.0% vs HGSOC 53.6% 95% CI 53.2%–54.2%) at diagnosis. (See Fig. 1.) After adjusting for age, stage, race, insurance status, and type of cancer program at which treatment was received, diagnosis with OCS was still associated with compromised OS (HR 2.0, 95% CI 1.8–2.2, P < .0001). Conclusions: Compared with HGSOC, OCS is associated with compromised OS and an increase in short-term mortality after surgery. Interventions aimed at decreasing short-term mortality and improving long-term outcomes should be the focus of future trials. Ongoing trials focused on this histologic subtype (i.e., GOG261) may determine the optimal treatment regimen for this disease.

Objectives: To determine whether receipt of full surgical staging for high-grade endometrial cancer is associated with socioeconomic factors, distance traveled to obtain care, and type of cancer treatment program. Methods: The National Cancer Data Base (NCDB) was searched for patients who underwent surgical treatment for grade 3 endometrioid, clear cell, and serous endometrial cancer from 1998 to 2012 in the Southeastern United States. Rates of NCCN guideline–based surgical staging and overall survival (OS) were the main outcome measures. Categorical variables were compared using chi-square tests. Multivariate logistic regression was used to examine differences in receipt of lymph node staging based on race (Caucasian [C] vs African American [AA]), income, type of cancer program (academic vs other), and distance to care (≤25 or >25 miles), controlling for Charlson comorbidity score. Multivariate Cox proportional hazards regression modeling was used to assess OS based on stage (I/II vs III/IV), race (C vs AA), income, and distance traveled (≤25 or >25 miles) controlling for age. Results: A total of 10,767 patients were identified who underwent surgery for high-grade endometrial cancer: 77% were Caucasian, 38% were privately insured, 35% traveled more than 25 miles for cancer treatment, and 37% had stage III/IV disease. Lymph node staging was more common among Caucasians (75% vs 70%, P < .0001), patients who traveled more than 25 miles (77% vs 72%, P < .0001), had higher income (76% vs 72%, P < .0001), or were treated at an academic center (77% vs 72%, P < .0001). In multivariate analysis, C race, higher income, academic/research program, Charlson score, and distance traveled to care were all significant predictors of lymph node staging. In Cox analysis, stage III/IV disease (HR 3.2, 95% CI 3.1–3.5), AA race (HR 1.4, 95% CI 1.2–1.5), lowest income quartile (HR 1.2, 95% CI 1.1–1.3) and traveling more than 25 miles to care (HR 1.1, 95% CI 1.0–1.2) were significant predictors of lower survival. Conclusions: Women with high-grade endometrial cancer in the Southeast do not receive uniform surgical care, with travel distance, race, income, and academic treatment center each strongly associated with receipt of guideline-consistent staging. Community-based patient navigation systems are needed as an interface between the highest-risk patients and high-quality care.