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Disparities in the surgical staging of high-grade endometrial cancer in the United States.

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Date
2017
Authors
Foote, Jonathan R
Gaillard, Stephanie
Broadwater, Gloria
Sosa, Julie A
Davidson, Brittany
Adam, Mohamed A
Secord, Angeles Alvarez
Jones, Monica B
Chino, Junzo
Havrilesky, Laura J
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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 article
Subject
Disparity
Endometrial cancer
High-grade
NCDB
Staging
Surgical volume
Permalink
https://hdl.handle.net/10161/14627
Published Version (Please cite this version)
10.1186/s40661-016-0036-3
Publication 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.
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Scholars@Duke

Chino

Junzo Paul Chino

Associate Professor of Radiation Oncology
Clinical Research in Gynecologic Malignancies, Breast Malignancies, Radiation Oncology Resident Education, Stereotactic Radiation Therapy, and Brachytherapy
Davidson

Brittany A Davidson

Associate Professor of Obstetrics and Gynecology
Havrilesky

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
Secord

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
Sosa

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
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