L. V. Bownes1, I. I. Maizlin1, K. Gow2, M. Langer5, M. Goldfarb3, M. Raval7, J. Doski6, A. Goldin2, J. Nuchtern4, S. Vasudevan4, E. A. Beierle1 1University Of Alabama at Birmingham,Division Of Pediatric Surgery,Birmingham, Alabama, USA 2University Of Washington,Seattle, WA, USA 3Providence Saint John’s Health Center,Santa Monica, CA, USA 4Baylor College Of Medicine,Houston, TX, USA 5Maine Medical Center,Portland, ME, USA 6University Of Texas Health Science Center At San Antonio,San Antonio, TX, USA 7Emory University School Of Medicine,Atlanta, GA, USA
Introduction: Malignant ovarian germ cell tumors (MOGCT) comprise approximately 5% of primary ovarian malignancies. Although current treatments provide excellent outcomes, survival has been shown to be related to race and age. Socioeconomic (SE) factors have been proposed to affect survival in other cancers, but their effect on survival in MOGCT has yet to be evaluated. Therefore, we examined whether SE status impacted the survival of adolescent and young adult women (AYA) with MOGCT.
Methods: The National Cancer Data Base was used to identify all AYA female patients (14-39 years old) with diagnosis of MOGCT from 1998 to 2012. Three SE surrogate variables were identified: insurance type (private, government, uninsured), median income and percent of people without a high school degree in patient’s ZIP code. Pooled-variance t-tests and χ2 were used to compare tumor characteristics, time from diagnosis to staging and to treatment, and clinical outcome variables within each of the SE surrogate variables, while controlling for the effect of age and race in a multivariate model.
Results: 3125 AYA patients were diagnosed with MOGCT. Controlling for age and race, there were significant differences in tumor stage and size at diagnosis when compared between insurance groups, income, and education quartiles in patients within lower quartiles of all measures having larger and more aggressive tumors (Table). Following diagnosis, there was no significant difference in time to tumor staging between insurance groups (p=0.062), income quartiles (p=0.196) or education level (p=0.417). Similarly, there was no association of insurance (p=0.85), income (p=0.28), or education (p=0.61) levels in time to treatment. No significant difference was found between the groups in type of surgery. Survival analysis demonstrated higher mortality to be associated with lower level of education (p=0.001; Hazard Ratios [HR] = 0.87, 0.52 and 0.39, compared to lowest quartile), income quartile (p=0.002; HR=0.54, 0.39 and 0.34, compared to lowest quartile) and insurance status (p<0.001; HR=0.61 for government insurance, HR=0.46 for private insurance, compared to uninsured). Controlling for stage and size of tumor, the difference in survival loses significance, indicating that the original difference in survival is likely due to disparity in extent of disease at presentation.
Conclusions: Female AYA patients from lower SE status with MOGCT presented with more extensive disease, which translated into lower survival, despite similar treatment patterns and equal time to definitive treatment. The underlying factors resulting in these differences must be further examined as potential targets for improved education and access to initial care.
