Socioeconomic disparities affect survival in malignant ovarian germ cell tumors in AYA population

• Authors: LV Bownes, University of Alabama Birmingham; LL Stafman, University of Alabama Birmingham; II Maizlin, University of Alabama Birmingham; M Dellinger, Seattle Children's Hospital; KW Gow, Seattle Children's Hospital; AB Goldin, Seattle Children's Hospital; M Goldfarb, Providence St. John’s Health Center; M Langer, Tufts University; Mehul Raval, Emory University; JJ Doski, University of Texas Health Science Center; JG Nuchtern, Texas Children’s Hospital; SA Vasudevan, Texas Children’s Hospital; EA Beierle, University of Alabama Birmingham
• Journal Title: Journal of Surgical Research
• Volume: Volume 222
• Publisher: ACADEMIC PRESS INC ELSEVIER SCIENCE | 2018-02-01, Pages 180-+
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jss.2017.09.013
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Surgery; Socioeconomic; Disparity; MOGCT; Survival; Stage; CANCER DATA-BASE; RACIAL DISPARITIES; YOUNG-ADULTS; ADOLESCENTS

Abstract

Background: Malignant ovarian germ cell tumors (MOGCTs) are a rare form of ovarian malignancy. Socioeconomic status (SES) has been shown to affect survival in several gynecologic cancers. We examined whether SES impacted survival in adolescent and young adults (AYAs) with MOGCT. Materials and methods: The National Cancer Data Base was used to identify AYAs (aged 15-39 years) with MOGCT from 1998 to 2012. Three SES surrogate variables identified were as follows: insurance type, income quartile, and education quartile. Pooled variance t-tests and chi-square tests were used to compare tumor characteristics, the time from diagnosis to staging/treatment, and clinical outcome variables for each SES surrogate variable, while controlling for age and race/ethnicity in a multivariate model. Kaplan–Meier survival estimates were calculated using the log-rank test. Results: A total of 3125 AYAs with MOGCT were identified. Subjects with lower SES measures had higher overall stage and T-stage MOGCTs at presentation. There was no significant difference in the time to staging/treatment, extent of surgery, or use of chemotherapy by SES. Subjects from a lower education background, from a lower income quartile, and without insurance had decreased survival (P ≤ 0.02 for all). Controlling for overall stage and T-stage, the difference in survival was no longer significant. Conclusions: AYAs with MOGCT from lower SES backgrounds presented with more advanced stage disease. Further studies that focus on the underlying reasons for this difference are needed to address these disparities.