African-American women with advanced endometrial cancer have more aggressive tumors than Caucasian women

In two studies of African-American women with endometrial cancer, a group of investigators from Walter Reed Army Medical Center and the National Cancer Institute has found that African-American women with advanced endometrial cancer have more aggressive tumors than Caucasian women, potentially leading to worse outcomes.

Specifically, the investigators first performed a retrospective study of data from four treatment trials carried out by the Gynecologic Oncology Group (GOG) in a clinical trial setting where patients receive similar care, to determine if outcomes remain poor for African-American women with endometrial cancer. The GOG is an NCI-funded national cooperative group that coordinates most of the large therapeutic gynecologic cancer studies in the U.S.

In this study, the survival rates for 168 African-American patients and 997 Caucasian patients with Stage III, Stage IV or recurrent endometrial cancer were analyzed and compared. This analysis showed that African-American women with advanced endometrial cancer have a 25 percent greater chance of dying than Caucasian patients with the same diagnosis, even in the setting of a controlled clinical trial.

Based on the clinical data from the GOG study, the investigators hypothesized that there may be biologic differences in endometrial cancers in African-American women compared to Caucasian women that lead to more aggressive tumors. The investigators subsequently performed a study evaluating global gene expression among patients with advanced endometrial cancer using tumor samples from patients treated at Duke University Medical Center.

Cancers from 18 African-American patients were compared to those from 27 Caucasian patients who were matched according to stage, grade and cell type.

It was found that distinct and different patterns of gene expression may characterize advanced endometrial cancers in African-American and Caucasian women, and that these underlying molecular differences may partially explain the racial disparity in survival outcome.

More information about the studies can be found in the manuscripts:

• "Racial disparity in survival among patients with advanced/recurrent endometrial adenocarcinoma: a Gynecologic Oncology Group Study"
• "Racial disparity in global gene expression among patients with advanced endometrial adenocarcinoma"

"Both of these studies on racial disparities between African-American and Caucasian women with endometrial cancer suggest that a biologic reason may in part underlie the 'aggressive' endometrial cancers that develop in some African-American patients," said LTC Larry Maxwell, MD, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center. "Further research is needed to determine how these differences can be studied to help identify better therapies for high-risk minority groups."

The authors of the first study are: LTC G. Larry Maxwell, MD, Walter Reed Army Medical Center and the National Cancer Institute; G.V.R. Chandramouli, PhD, National Cancer Institute; Lou Dainty, MD, Walter Reed Army Medical Center; Tracy Litzi, MS, National Cancer Institute; Michael A. Bidus, MD, Walter Reed Army Medical Center; Andrew Berchuck, MD, Duke University Medical Center; J. Carl Barrett, PhD, National Cancer Institute; and John I. Risinger, PhD, National Cancer Institute.

The authors of the second study are: LTC G. Larry Maxwell, MD, Walter Reed Army Medical Center and the National Cancer Institute; Chunqiao Tian, MD, Gynecologic Oncology Group Statistical and Data Center; John I. Risinger, PhD, National Cancer Institute; Carol Brown, MD, Memorial Sloan Kettering; Tate Thigpen, MD, University of Mississippi Medical Center; Gini Fleming, MD, University of Chicago; Holly Gallion, MD, Precision Therapeutics; and Wendy Brewster, MD, University of California Irvine Medical Center.

According to the American Cancer Society, this year in the U.S. there will be approximately 40,880 women diagnosed with endometrial cancer, which is also known as uterine cancer, and 7,310 deaths from the disease. Endometrial cancer is the most common cancer of the female reproductive organs.