High-Grade Cancer, But Not SVM, Is Associated With OS Disparities in Black Patients With Uterine Carcinoma

Findings from a retrospective study showed that high-grade cancer was associated with disparities in overall survival (OS) outcomes between races in patients with uterine carcinoma; however, social vulnerability metric (SVM) was not associated with survival disparities in this cohort. Data were presented at the 2025 Society of Gynecologic Oncology Winter Meeting.

“Black women develop high-grade endometrial carcinoma at higher rates than White women,” lead study author Gabrielle Sudilovsky, of the University of Chicago Pritzker School of Medicine, and colleagues wrote in a poster presentation of the data. “Black patients have worse OS across different levels of vulnerability; however, in this cohort, high-grade cancer and not SVM was associated with disparities in OS across races.”

Results showed that OS outcomes were worse among Black patients compared with White, Hispanic, and other patients across all histologies (P < .0001). Higher-stage disease was negatively associated with worse OS outcomes (HR, 1.35; 95% CI, 1.24-1.47).

The vast majority of patients classified into the lowest SVM quartile were White, whereas most patients in the highest quartile were Black. However, compared with the lower SVM quartiles, OS outcomes were similar in the second (HR, 0.86; 95% CI, 0.66-1.11), third (HR, 1.08; 95% CI, 0.75-1.56), and fourth/highest (HR, 1.03; 95% CI, 0.74-1.43) quartiles.

Study Design

Researchers conducted a retrospective review of patients with uterine carcinoma treated at the University of Chicago between 2006 and 2003. Patient data, including demographics, clinical characteristics, and outcomes, were gathered from the university’s cancer registry.

Investigators evaluated differences in the rates of high-grade disease (uterine serous carcinoma or uterine carcinosarcoma) vs low-grade disease (grade 1/2 endometrioid) by SVM quartiles. OS was analyzed by histologic type and race between the lowest and highest quartiles of SVM.

SVM incorporated factors such as demographics, education, health care, economic context, and physical infrastructure.

Patient Demographics

The overall cohort included 1350 patients with a mean age at diagnosis of 62.7 years (standard deviation, 11.2). Among all patients, 22.8% were 71 years of age or older, 37.2% were between 61 and 70 years of age, 27.7% were 51 to 60 years of age, and 12.2% were 50 years of age or younger.

White patients comprised 55.1% of the overall population, and 35.0% of patients were Black. Racial distribution varied by histologic subtype; Black patients represented 53.8% of patients with carcinosarcoma (n = 184) and 52.1% of patients with serous carcinoma (n = 259). White patients comprised 61.5% of those with endometrioid carcinoma (n = 907). Additionally, 53.9% of the overall population had public insurance.

At diagnosis, patients had stage I (65.5%), stage II (7.4%), stage III (15.4%), or stage IV (11.7%) disease. Disease grades included 1 (50.2%), 2 (32.6%), 3 (14.4%), or unknown (2.7%).

Patients classified in the highest SVM quartile accounted for 29.1% of all patients; the rates of patients classified into the first, second, and third SVM quartiles were 36.8%, 21.8%, and 29.1%, respectively.

Authors noted that limitations to the retrospective study included limited sample size and no true control over the study. They also cited the need to expand from a single-institution cohort to a larger group.

“Further investigation should focus on understanding other reasons for the disparity in outcomes by race,” Sudilovsky concluded.

Reference

Sudilovsky G, Tilmon S, Che Y, et al. Racial disparities in high-grade uterine carcinoma: socioeconomic status does not bridge the gap. Presented at: SGO 2025 Winter Meeting; January 30 - February 1, 2025; Whistler, British Columbia, Canada.