Improved survival of Asians with corpus cancer compared with whites - An analysis of underlying factors

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.