Analysis of racial disparities in stage IIIC epithelial ovarian cancer care and outcomes in a tertiary gynecologic oncology referral center.

OBJECTIVE: To examine disparities in delivery of care and survival according to racial classification among White and African-American women with Stage IIIC epithelial ovarian cancer undergoing initial treatment in a tertiary referral center setting. METHODS: All consecutive patients diagnosed with Stage IIIC epithelial ovarian cancer between 1/1/95 and 12/31/08 were identified and clinic-pathologic variables retrospectively collected. Differences in initial treatment paradigm, surgical and adjuvant therapy, and overall survival according to racial classification were assessed by univariate and multivariate analyses. RESULTS: A total of 405 patients (White, n=366; African-American, n=39) were identified. There were no significant differences according to racial classification in age, CA125, ASA class, histology, tumor grade, the frequency of initial surgery (90.4% vs 82.1%, p=0.06), optimal residual disease (73.0% vs 69.2%, p=0.28), no gross residual disease (51.4% vs 53.8%, p=0.49), and platinum-taxane chemotherapy (88.3% vs 87.2%, p=0.55). The median overall survival for White patients was 50.5 months (95%CI=43.2-57.9 months), compared to 47.0 (95%CI=36.2-57.8) months for African-Americans (p=0.57). On multivariate analysis, age, tumor grade 3, serum albumin <3.0 g/dl, platinum-based chemotherapy, and no gross residual disease were independently associated with overall survival, while African-American race was not (HR=1.06, 95%CI=0.61-1.79). CONCLUSIONS: Among women undergoing initial treatment for ovarian cancer at a tertiary referral center, African-American patients were as likely as White patients to undergo cytoreductive surgery, be left with minimal post-surgical residual disease, and receive appropriate chemotherapy. With equal access to gynecologic oncology care and multidisciplinary cancer resources, the survival disparities according to race observed in population-based studies are largely mitigated.

Priapism in the United States: the changing role of sickle cell disease.

BACKGROUND: Few patients with priapism require inpatient management unless they are refractory to intracavernosal therapy. Their risk factors and outcomes are poorly characterized. METHODS: This is a retrospective analysis of the Nationwide Inpatient Sample (1998-2006). Priapism patients were identified and analyzed over time by age, race, sickle-cell disease diagnosis, drug abuse, and penile operations. RESULTS: A total of 4,237 hospitalizations for priapism were identified (30% white, 61.1% black, and 6.3% Hispanics). There was an increasing incidence of priapism over time, concentrated in the middle-age group. There were 1,776 patients (41.9%) with diagnoses of sickle-cell disease, with decreasing proportions over time. Drug abuse was reported in 7.9%. CONCLUSIONS: Inpatient diagnoses of priapism are increasing over time with relatively constant numbers of sickle-cell disease patients, suggesting rising nonhematologic causes of priapism. One theory is that increasing use of aggressive therapies for erectile dysfunction might play a role, especially when combined with drug abuse.