Disparities in the surgical staging of high-grade endometrial cancer in the United StatesReport as inadecuate

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Gynecologic Oncology Research and Practice

, 4:1

First Online: 19 January 2017Received: 02 October 2016Accepted: 28 December 2016DOI: 10.1186-s40661-016-0036-3

Cite this article as: Foote, J.R., Gaillard, S., Broadwater, G. et al. gynaecol oncol res pract 2017 4: 1. doi:10.1186-s40661-016-0036-3


BackgroundThe 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.

MethodsThe 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.

ResultsForty-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.

ConclusionsSurgical 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.

KeywordsEndometrial cancer Disparity High-grade Staging NCDB Surgical volume AbbreviationsACSAmerican College of surgeons

AJCCAmerican joint committee on cancer

BMIBody mass index

CCClear cell

CoCCommission on cancer

FIGOInternational federation of gynecology and obstetrics

LNSLymph node sampling

NCCNNational comprehensive cancer network

NCDBNational cancer data base

OSOverall survival

SGOSociety of gynecologic oncology

UPSCUterine papillary serous carcinoma

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Author: Jonathan R. Foote - Stephanie Gaillard - Gloria Broadwater - Julie A. Sosa - Brittany Davidson - Mohamed A. Adam - Angele

Source: https://link.springer.com/

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