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

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

England

2017-06-01T14:04:06Z

2017-06-01T14:04:06Z

2017

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.

https://www.ncbi.nlm.nih.gov/pubmed/28116108

36

https://hdl.handle.net/10161/14627

eng

Springer Science and Business Media LLC

Gynecol Oncol Res Pract

10.1186/s40661-016-0036-3

Disparity

Endometrial cancer

High-grade

NCDB

Staging

Surgical volume

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

Journal article

Sosa, Julie A|0000-0002-3356-7316

Chino, Junzo|0000-0002-3633-9685

https://www.ncbi.nlm.nih.gov/pubmed/28116108

1

Clinical Science Departments

Duke

Duke Cancer Institute

Duke Clinical Research Institute

Institutes and Centers

Medicine

Medicine, Medical Oncology

School of Medicine

Published online

4