Disparities in the surgical staging of high-grade endometrial cancer in the United States.
Abstract
BACKGROUND: The National Comprehensive Cancer Network (NCCN) and the Society of Gynecologic
Oncology (SGO) recommend lymph node sampling (LNS) as a key component in the surgical
staging of high-grade endometrial cancer. Our goal was to examine surgical staging
patterns for high-grade endometrial cancer in the United States. METHODS: The National
Cancer Data Base (NCDB) was searched for patients who underwent surgery for serous,
clear cell, or grade 3 endometrioid endometrial cancer. Outcomes were receipt of LNS
and overall survival (OS). Multivariate logistic regression was used to examine receipt
of LNS in Stage I-III disease based on race (White vs. Black), income, surgical volume,
and distance traveled to care. Multivariate Cox proportional hazards regression modeling
was used to assess OS based on stage, race, income, LNS, surgical volume, and distance
traveled. RESULTS: Forty-two thousand nine hundred seventy-three patients were identified:
76% White, 53% insured by Medicare/Medicaid, 24% traveled >30 miles, and 33% stage
III disease. LNS was similar among White and Black women (81% vs 82%). LNS was more
common among >30 miles traveled (84% vs 81%, p < 0.001), higher surgical volume (83%
vs 80%, p < 0.001), and academic centers (84% vs 80%, p < 0.001). In multivariate
analysis, higher income, higher surgical volume, Charlson-Deyo score, and distance
traveled were predictors of LNS. Stage III disease (HR 3.39, 95% CI 3.28-3.50), age
(10-year increase; HR 1.63, 95% CI 1.61-1.66), lack of LNS (HR 1.64, 95% CI 1.56-1.69),
and low income (HR 1.20, 95% CI 1.14-1.27) were predictors of lower survival. CONCLUSIONS:
Surgical care for high-grade endometrial cancer in the United States is not uniform.
Improved access to high quality care at high volume centers is needed to improve rates
of recommended LNS.
Type
Journal articlePermalink
https://hdl.handle.net/10161/14627Published Version (Please cite this version)
10.1186/s40661-016-0036-3Publication Info
Foote, Jonathan R; Gaillard, Stephanie; Broadwater, Gloria; Sosa, Julie A; Davidson,
Brittany; Adam, Mohamed A; ... Havrilesky, Laura J (2017). Disparities in the surgical staging of high-grade endometrial cancer in the United
States. Gynecol Oncol Res Pract, 4. pp. 1. 10.1186/s40661-016-0036-3. Retrieved from https://hdl.handle.net/10161/14627.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Junzo Paul Chino
Associate Professor of Radiation Oncology
Clinical Research in Gynecologic Malignancies, Breast Malignancies, Radiation Oncology
Resident Education, Stereotactic Radiation Therapy, and Brachytherapy
Brittany A Davidson
Associate Professor of Obstetrics and Gynecology
Laura Jean Havrilesky
Professor of Obstetrics and Gynecology
I am interested in using health economic models to inform decisions related to gynecologic
cancers. Specific models have addressed the decision to administer intraperitoneal
chemotherapy for newly diagnosed advanced ovarian cancer following optimal cytoreduction,
the choice of chemotherapy regimen for recurrent platinum-sensitive ovarian cancer,
and the exploration of screening strategies for ovarian cancer. The ovarian cancer
screening model examines the effects of test cost, sensitivity
Angeles Alvarez Secord
Professor of Obstetrics and Gynecology
My primary research interest has focused on on novel therapeutics, biomarkers and
clinical trial development for ovarian and endometrial cancer. My fundamental goal
is to develop a strong translational research program at Duke University in the Gynecologic
Oncology Division, where knowledge we glean from our basic science research can be
incorporated into our clinical trial program. Specifically, my focus is on biologic
therapy and molecular biomarkers to direct therapy in patients with ovari
Julie Ann Sosa
Professor of Surgery
Julie Ann Sosa, MD MA FACS is Chief of Endocrine Surgery at Duke University and leader
of the endocrine neoplasia diseases group in the Duke Cancer Institute and the Duke
Clinical Research Institute. She is Professor of Surgery and Medicine. Her clinical
interest is in endocrine surgery, with a focus in thyroid cancer. She is widely published
in outcomes analysis, as well as cost-effectiveness analysis, meta-analysis, and survey-based
research, and she is director of health services research for
Alphabetical list of authors with Scholars@Duke profiles.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info