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

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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
Abstract
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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Autor: Jonathan R. Foote - Stephanie Gaillard - Gloria Broadwater - Julie A. Sosa - Brittany Davidson - Mohamed A. Adam - Angele
Fuente: https://link.springer.com/