The impact of nativity on uterine cancer survival in the public hospital system of Queens, New York.

OBJECTIVE: We studied cis-women with uterine cancer presenting to the two Public Hospitals in Queens, New York from 2006 to 2015 to examine the relationship between nativity (birthplace) and survival. METHODS: A retrospective review of tumor registries identified women diagnosed with uterine cancer between January 1, 2006, and December 31, 2015. Data from 259 women were available for this analysis. RESULTS: Most women were born outside the United States (US) (76% versus 24%). The majority of US-born women were black (68%). Seventy-seven women (30%) were born in Latin America, 76 in the Caribbean Islands (29%) and 44 in Asia/South Asia (17%). Most women presented with stage I/II disease (70%) and endometrioid/mucinous histology (68%) with no significant differences observed among nativity groups. Kaplan-Meier estimated survival curves stratified by birthplace demonstrated significant differences in survival distributions among the groups using the log-rank test (P < 0.0001). The most favorable survival curves were observed among all foreign-born women, whereas the least favorable survival was demonstrated in US-born women. Time to death was analyzed using the Cox proportional hazards model. Adjusting for age of diagnosis, insurance status, stage, and treatment modality, Latin American and Asia/South Asia birthplace was significantly associated with increased survival time. CONCLUSION: An immigrant health paradox was defined for foreign-born Latin American and Asian/South Asian women presenting to the two Public Hospitals of Queens, New York, as women born in these geographic regions were less likely to die at any given time compared to those born in the United States.

The impact of nativity on cervical cancer survival in the public hospital system of Queens, New York.

OBJECTIVE: We studied cervical cancer patients who presented to the Public Hospital System in ethnically-diverse Queens, New York from 2000 to 2010 with the purpose of examining the relationship between nativity (birthplace) and survival. METHODS: A retrospective review of tumor registries was used to identify patients diagnosed with cervical cancer between January 1, 2000 and December 31, 2010. Using electronic medical records, data from 317 patients were available for this analysis. RESULTS: The majority of patients were born outside the United States (US) (85.5% versus 14.5%). One hundred patients (31.5%) were born in Latin America, 105 in the Caribbean Islands (33.1%), 48 in Asia (15.1%), 8 in the South Asia (2.5%), 10 in Russia/Eastern Europe (3.2%) and 46 (14.5%) in the United States. Patients presented at varying stages of disease: 51.4% at stage I, 19.6% at stage II, 19.6% at stage III, and 8.5% at stage IV. Kaplan-Meier estimated survival curves stratified by birthplace demonstrated significant differences in survival distributions among the groups using the log-rank test (P<0.0001). The most favorable survival curves were observed among patients born in Latin America and Asia whereas the least favorable was demonstrated in US-born patients. Time to death was analyzed using the Cox proportional hazards model. Adjusting for age at diagnosis, insurance status, stage and treatment modality, nodal metastases and hydronephrosis, birthplace was significantly associated with survival time (P<0.0001). CONCLUSION: An immigrant health paradox was defined for foreign-born Latino and Asian patients presenting with cervical cancer to the Public Hospital System of Queens, New York as patients born in Latin America and Asia were less likely to die at any given time compared to those born in the United States.

Vaginal metastases in gestational trophoblastic neoplasia.

OBJECTIVE: To evaluate the clinical experience and outcomes of patients with gestational trophoblastic neoplasia (GTN) complicated by vaginal metastases. STUDY DESIGN: A review of patients with vaginal metastases from GTN treated at a regional trophoblastic disease center from 1962 to 2006. RESULTS: Vaginal metastases were present in 36 (4.5%) of the 804 patients treated for GTN. FIGO stage was II in 13 patients (36%), III in 22 patients (61%) and IV in 1 patient (3%). Twenty-three patients (65%) were low-risk by modified WHO criteria. The vaginal metastases were most frequently single lesions (61%) on the anterior vaginal wall (49%) with a histologic classification of choriocarcinoma (67%). Significant bleeding necessitated blood transfusion (median, 7 units; range, 1-26 units) in 13 patients (36%). Seven patients (19%) required 1 or more procedures for control of bleeding, including excision, suturing and/or hypogastric artery ligation/embolization. Twenty-three patients (64%) received single-agent chemotherapy with methotrexate and/or actinomycin-D, while 13 patients (36%) received multiagent chemotherapy regimens. CONCLUSION: Overall, 29 (81%) of 36 patients with vaginal metastases were cured. Vaginal metastasis from GTN does not uniformly confer a worse prognosis or necessitate multiagent chemotherapy, although procedures for control of bleeding may be required.