The Impact of Racial and Ethnic Background on Overall Survival in Endometrial Cancer Patients Receiving Immunotherapy as Front-Line Treatment

Background/Objective: For decades, non-Hispanic Black and Hispanic patients have been reported to have worse outcomes in endometrial cancer compared to non-Hispanic White patients. More recently, the introduction of immunotherapy has improved outcomes for patients with advanced and recurrent endometrial cancer. In this study, we examined the impact of race and ethnicity on overall survival in patients with endometrial cancer who received immunotherapy. Methods: Patients with endometrial cancer who received immunotherapy between 2019 and 2022 were identified in the National Cancer Database. Demographic, socioeconomic, and clinicopathological characteristics were evaluated. The association between race/ethnicity and overall survival was examined using Kaplan–Meier and multivariable Cox regression. Results: We identified 4322 patients (68% non-Hispanic White, 21% non-Hispanic Black, 7% Hispanic, and 4% Asian). Non-Hispanic Black patients had similar overall survival rates compared to non-Hispanic White patients (aHR 1.03, 95% CI 0.86–1.23), despite having the highest frequency of serous histology, an aggressive subtype (51% vs. 36%, p < 0.001). Hispanic patients, who were younger (p < 0.001) and had a higher frequency of Medicaid insurance compared to the overall cohort (p < 0.001), had worse survival compared to non-Hispanic White patients (aHR 1.37, 95% CI 1.05–1.80) in a multivariate model controlling for differences in demographic, socioeconomic, and clinical variables. Conclusions: For endometrial cancer patients receiving immunotherapy, there were no differences in survival between non-Hispanic White and non-Hispanic Black patients. However, Hispanic patients continue to experience significantly worse outcomes that cannot be explained only by disparity in access to novel treatments. More studies are warranted to better identify the causes driving the differences to improve outcomes for all patients.