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Obstetrics & Gynecology 2006;107:329-335
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Improved Survival of Asians With Corpus Cancer Compared With Whites

An Analysis of Underlying Factors

Mallory M. Zhang, MD1, Michael K. Cheung1, Kathryn Osann, PhD3, Marion M. Lee, PhD4, Scarlett S. Lin Gomez, PhD5, Alice S. Whittemore, PhD2, Amreen Husain, MD1, Nelson N. Teng, MD, PhD1 and John K. Chan, MD1

From the 1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and 2Department of Health and Research Policy, Stanford Cancer Center, Stanford University School of Medicine, Stanford, California; 3Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chao Family Comprehensive Cancer Center, University of California, Irvine–Medical Center, Orange, California; 4Department of Epidemiology and Biostatistics, Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California; and 5Northern California Cancer Center, Union City, California.

OBJECTIVE: To compare the clinicopathologic prognosticators and survival of Asians and whites with corpus cancer.

METHODS: Demographic, clinicopathologic, and survival data were obtained from the 1992–2001 Surveillance, Epidemiology, and End Results Program. Statistical analyses were performed by Kaplan-Meier methods and Cox proportional hazards model.

RESULTS: A total of 2,144 Asians and 32,999 whites with corpus cancer were identified. The age-adjusted incidence of uterine cancer in Asians compared with whites was 16.8 compared with 26.1 per 100,000. Asians presented at a younger age (mean 58.4 years compared with 65.1; P < .01) and with more advanced stage disease than whites (21.5% compared with 15.4%; P < .01). The 5-year survival rate for Asians was 79.4% compared with 75.2% for whites (P < .01). Asians with stage I-II and III-IV cancers had 5-year survival rates of 89.3% and 41.2% compared with 82.3% and 34.0% for the whites, respectively (P < .01, early stage; P < .01, advanced stage). The survival advantage of Asians persists in endometrioid (P < .01) and uterine papillary serous carcinomas (P < .01), but not in clear cell carcinoma (P = .62) or sarcomas (P = .78). In multivariate analysis, younger age (P < .01), earlier stage (P < .01), favorable histology (P < .01), and lower grade (P < .01) remained as significant independent prognosticators for improved survival. However, race was not an important prognosticator.

CONCLUSION: The overall survival advantage experienced by Asians with uterine cancer is attributable to their younger age at diagnosis. Because Asian women present at a younger age with more advanced disease, physicians should have an increased index of suspicion for malignancy in young Asian women with suspicious symptoms and consider a lower age threshold for biopsy in this group.

LEVEL OF EVIDENCE: II-2






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