Influence of race, ethnicity, and nativity on distribution and outcomes among women with choriocarcinoma.

Abstract

e17653 Background: Gestational trophoblastic neoplasia (GTN) is a rare group of malignancies in which abnormal trophoblastic (placental) cells proliferate in the uterus following normal or abnormal gestations, representing only 1% of female reproductive cancers. Limited research on choriocarcinoma demonstrates that minority races are more likely to have distant disease at the time of diagnosis and that race and or ethnicity may impact survival. We aimed to evaluate differences in disease presentation and outcomes by individual-level factors in women with choriocarcinoma, hypothesizing that minority patients would have varying overall survival when further disaggregated by nativity. Methods: We analyzed data from the Florida Cancer Data System (FCDS) surveying women with a diagnosis of choriocarcinoma from 1981 to 2020, limiting the primary site to the placenta. Clinicodemographic data, including self-identified race, ethnicity (non-Hispanic vs Hispanic) and country of birth (US-born vs non-US born) were extracted. Statistical analyses were done using Wilcoxon Rank Sum, Chi-square, and the Kaplan-Meier method, with significance of p<0.05. Results: We identified 262 patients who were eligible for inclusion. There was no significant difference in mean age at diagnosis by race (Black 28.4yrs vs White 28.9yrs, p=0.69). Black women were more likely to have distant disease at the time of diagnosis compared to White women (63.8% vs 46.2%, p=0.05). Place of birth, ethnicity, and race were not associated with overall survival (OS) (all p>0.05). In multivariable analyses adjusted by race and birthplace, increasing age (HR 1.05 [1.02-1.09], p=0.004), advanced stage (HR 1.75 [1.03-2.98], p=0.039), and treatment with surgery (HR 0.26 [0.11-0.61], p=0.002) were associated with OS. However, while the OS for the entire population was favorable, once outside of the initial diagnostic/treatment window, there was a divergence of the survival curves favoring White (vs Black) patients (25th percentile for OS White 243.6 months [95% CI 95.8-376.9] vs Black 55.3 months [95% CI 11.4-353.3]), though not statistically significant (p=0.15). Conclusions: In Florida, Black patients with choriocarcinoma present at higher stages of disease than White patients. Longitudinally, race may be a predictive factor in OS, though if this is mediated by choriocarcinoma itself or other disparities in healthcare access/utilization is unclear.