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A Three-dimensional Thymic Culture System to Generate Murine Induced Pluripotent Stem Cell-derived Tumor Antigen-specific Thymic Emigrants
Published on: August 9, 2019
Racial Disparities in Thymic Epithelial Tumors: Insights From a Multiracial Urban Cohort
Erica Pietroluongo1, Christine M Bestvina2, Anna Di Lello2
1Department of Medicine, Section of Hematology Oncology, Thoracic Oncology Program, The University of Chicago Medicine, Chicago, IL; Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Background:
Thymic epithelial tumors (TETs) are rare thoracic malignancies for which racial disparities in outcomes remain poorly characterized. We evaluated survival outcomes across racial groups and explored the clinical and sociodemographic factors that may help contextualize any observed differences.
Patients And Methods:
We retrospectively analyzed 128 consecutive patients with histologically confirmed TETs referred to the University of Chicago between January 1989 and March 2024. Associations between race, socioeconomic variables, and overall survival (OS) were evaluated using multivariable logistic regression, Cox proportional hazards models, and inverse probability of treatment weighting with average treatment effect (IPTW-ATE).
Results:
Among 128 patients (75 White, 58%; 31 Black, 24%), Black race showed numerically worse OS on univariable analysis (hazard ratios [HR] 1.90, 95% confidence intervals [CI] 0.93-3.88; P = .077). Socioeconomic disparities were substantial: 74.2% of Black patients resided in low-income areas versus 12.2% of White patients (adjusted odds ratio 4.45, 95% CI 2.60-7.64; P < .0001). On multivariable analysis, thymic carcinoma histology (HR 3.97; P = .0012) and age older than 60 years (HR 2.19; P = .032) independently predicted worse survival. Black patients demonstrated numerically poorer OS (HR 2.49; P = .098). After IPTW-ATE adjustment, the association between Black race and OS was attenuated (HR 1.66, 95% CI 0.82-3.33; P = .157).
Conclusion:
Socioeconomic disadvantage emerged as one of several factors that may help contextualize the observed survival disparities in TETs. The attenuation of the effect estimates after adjustment for area-level socioeconomic factors suggests that social determinants of health may be relevant to the interpretation of these findings. Larger multi-institutional studies are needed to validate these observations.