Analysis of racial disparities in stage IIIC epithelial ovarian cancer care and outcomes in a Tertiary Gynecologic Oncology Referral Center

ObjectiveTo examine disparities in delivery of care and survival according to racial classification among White and African-American women with Stage IIIC epithelial ovarian cancer undergoing initial treatment in a tertiary referral center setting.MethodsAll consecutive patients diagnosed with Stage IIIC epithelial ovarian cancer between 1/1/95 and 12/31/08 were identified and clinic-pathologic variables retrospectively collected. Differences in initial treatment paradigm, surgical and adjuvant therapy, and overall survival according to racial classification were assessed by univariate and multivariate analyses.ResultsA total of 405 patients (White, n = 366; African-American, n = 39) were identified. There were no significant differences according to racial classification in age, CA125, ASA class, histology, tumor grade, the frequency of initial surgery (90.4% vs 82.1%, p = 0.06), optimal residual disease (73.0% vs 69.2%, p = 0.28), no gross residual disease (51.4% vs 53.8%, p = 0.49), and platinum-taxane chemotherapy (88.3% vs 87.2%, p = 0.55). The median overall survival for White patients was 50.5 months (95%CI = 43.2–57.9 months), compared to 47.0 (95%CI = 36.2–57.8) months for African-Americans (p = 0.57). On multivariate analysis, age, tumor grade 3, serum albumin < 3.0 g/dl, platinum-based chemotherapy, and no gross residual disease were independently associated with overall survival, while African-American race was not (HR = 1.06, 95%CI = 0.61–1.79).ConclusionsAmong women undergoing initial treatment for ovarian cancer at a tertiary referral center, African-American patients were as likely as White patients to undergo cytoreductive surgery, be left with minimal post-surgical residual disease, and receive appropriate chemotherapy. With equal access to gynecologic oncology care and multidisciplinary cancer resources, the survival disparities according to race observed in population-based studies are largely mitigated.

Research highlights
► African-American patients were as likely as White patients to undergo cytoreductive surgery, and receive appropriate chemotherapy.
► With equal access to gynecologic oncology care, the survival disparities according to race observed in population-based studies are largely mitigated.