Impact of patient neighborhood area deprivation index on prognostic factors and outcomes in endometrioid adenocarcinoma of the endometrium: a retrospective multi-center healthcare network analysis.

BACKGROUND

Neighborhood vulnerability, as measured by area deprivation index (ADI), has been associated with disparities across the cancer continuum; however, little is known about its impact on endometrial cancer. We sought to understand the impact of neighborhood deprivation on clinicopathologic features, stage at diagnosis, and outcomes for endometrioid endometrial carcinoma (EEC) within a large multicentered healthcare network.

METHODS

A retrospective review was conducted of Pennsylvania residents within a multicenter healthcare network diagnosed with EEC between 2018 and 2021(n = 1388). Demographic and pathologic factors were compared against dichotomized state-level ADI quantiles. Multivariable ordinal logistic regression explored the association between stage at diagnosis and ADI. Cox proportional hazard models assessed the association between ADI and progression-free (PFS) and overall survival (OS).

RESULTS

High ADI was associated with elevated BMI, non-White race, current smoking, and recurrence/progression on therapy. Although not statistically significant, the high ADI cohort tended to have increased rates of negative prognostic tumor features. Controlling for age and BMI, increasing ADI decile increased the odds of being diagnosed with a more advanced stage by 16% (p = 0.0004). In the adjusted cox regression model, higher ADI was associated with decreased PFS (aHR 1.42 [95% CI: 1.07, 1.88]), but not OS (aHR 1.16 [95% CI: 0.88, 1.55]). Additionally, when controlling for clinicopathologic tumor features, higher ADI was not associated with PFS or OS.

CONCLUSION

Among patients with EEC, higher neighborhood ADI was associated with higher odds of diagnosis at a later stage of disease and decreased PFS in multivariable analysis. Further research is needed to explore potential drivers of this relationship.