Disparities in the surgical staging of high-grade endometrial cancer in the United States.
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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.
Published Version (Please cite this version)10.1186/s40661-016-0036-3
Publication InfoAdam, MA; Broadwater, Gloria; Chino, Junzo Paul; Davidson, Brittany A; Foote, JR; Gaillard, Stephanie; ... Sosa, Julie Ann (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 http://hdl.handle.net/10161/14627.
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Associate Professor of Radiation Oncology
Clinical Research in Gynecologic Malignancies, Breast Malignancies, Radiation Oncology Resident Education, Stereotactic Radiation Therapy, and Brachytherapy
Assistant Professor of Obstetrics and Gynecology
Adjunct Assistant Professor in the Department of Medicine
Dr. Stéphanie Gaillard is an Assistant Professor in Medical Oncology at the Duke Cancer Institute. Dr. Gaillard is board certified by the American Board of Internal Medicine in both Internal Medicine and Medical Oncology. At Duke, she focuses on treating patients with gynecologic malignancies and conducts basic science and clinical research. Dr. Gaillard’s laboratory research focuses on elucidating the biology of ovarian cancer, especially metabolic changes in the development of ova
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
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