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Published on: September 15, 2017
Hispanic vs. Caucasian Race/Ethnicity in Adrenocortical Carcinoma Patients
Andrea Panunzio1,2, Stefano Tappero2,3,4, Cristina Cano Garcia2,5
1Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy; panunzioandrea@virgilio.it.
Insights
Hispanic race/ethnicity in adrenocortical carcinoma (ACC) patients is linked to younger diagnosis but not worse survival. This study found no significant survival disadvantage for Hispanics compared to Caucasians.
Area of Science:
- Endocrinology
- Oncology
- Epidemiology
Background:
- Hispanic race/ethnicity may be associated with advanced cancer stages and poorer outcomes in some cancers.
- Adrenocortical carcinoma (ACC) is a rare malignancy with limited data on racial/ethnic disparities.
Purpose of the Study:
- To investigate the association between Hispanic race/ethnicity and cancer-specific mortality (CSM) in ACC patients.
- To compare other-cause mortality (OCM) rates between Hispanic and Caucasian ACC patients.
Main Methods:
- Analysis of 1,060 ACC patients from the Surveillance, Epidemiology, and End Results database (2004-2018).
- Propensity score matching was used to balance baseline characteristics between 167 Hispanic and 893 Caucasian patients.
- Competing risk regression models were employed to assess mortality outcomes.
Main Results:
- Hispanic patients were diagnosed at a younger age (51 vs. 57 years) and had higher rates of advanced T3-4 tumor stage (52.7% vs. 42.8%).
- No significant differences were found in tumor grade, lymph node metastasis, distant metastasis, or European Network for the Study of Adrenal Tumors (ENSAT) stage.
- After propensity score matching, Hispanic race/ethnicity was not an independent predictor of higher CSM (HR=1.18, p=0.2).
Conclusions:
- Hispanic race/ethnicity in ACC is associated with younger age at diagnosis.
- Contrary to other cancers, Hispanic ethnicity in ACC does not appear to be linked to higher tumor stage or a survival disadvantage compared to Caucasians.
Background/Aim:
In primaries other than adrenocortical carcinoma (ACC), Hispanic race/ethnicity may predispose to higher stage at initial diagnosis and may result in worse survival. We tested the association between Hispanic race/ethnicity and cancer specific mortality (CSM) in ACC patients in addition to testing for differences in other-cause mortality (OCM) rates between Hispanics and Caucasians.
Patients And Methods:
Within Surveillance, Epidemiology, and End Results database (2004-2018), we identified 1,060 ACC patients: 167 (15.8%) Hispanics vs. 893 (84.2%) Caucasians. Propensity score matching (age, sex, grade, T, N and M stages, treatment types), cumulative incidence plots Poisson-smoothing and competing risk regression (CRR) were used.
Results:
Compared to Caucasians, Hispanics were younger (51 vs. 57 years, p<0.001) and presented higher rates of T3-4 primary tumor stage (52.7% vs. 42.8%, p=0.007). No other statistically significant differences were observed for grade, lymph node invasion, distant metastases, European Network for the Study of Adrenal Tumors (ENSAT) stage and treatment type (p>0.05 in all cases). After matching (1:3), 167 Hispanics and 501 Caucasians remained and were included in CRR analyses. In Hispanics, five-year CSM rates were 38.0% and 78.8% in respectively ENSAT stages I-II and III-IV vs. 34.1% and 74.4% in Caucasians. Overall, five-year OCM rates were 10.7% vs. 9.0% in Hispanics and Caucasians, respectively. In multivariable CRR models, Hispanic race/ethnicity was not an independent predictor for higher CSM (hazard ratio=1.18, p=0.2).
Conclusion:
In ACC, relative to Caucasians, Hispanic race/ethnicity is associated with lower age at initial diagnosis, but not with higher tumor stage or survival disadvantage.
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