Refusal of surgery and survival outcomes in endometrial cancer.

Published on Aug 12, 2021in International Journal of Gynecological Cancer2.095
· DOI :10.1136/IJGC-2021-002692
Alli M. Straubhar3
Estimated H-index: 3
(UofU: University of Utah),
Matthew Parsons4
Estimated H-index: 4
(HCI: Huntsman Cancer Institute)
+ 2 AuthorsKathryn A. Maurer3
Estimated H-index: 3
(UofU: University of Utah)
Sources
Abstract
OBJECTIVES The goal of this study was to determine the impact refusal of surgery has on overall survival in patients with endometrial cancer. METHODS From January 2004 to December 2015, the National Cancer Database was queried for patients with pathologically proven endometrial cancer who were recommended surgery and refused. Inverse probability of treatment weighting was used to account for differences in baseline characteristics between patients who underwent surgery and those who refused. Kaplan-Meier analyses and doubly robust estimation with multivariate Cox proportional hazards modeling were used to analyze overall survival. RESULTS Of the 300 675 patients identified, 534 patients (0.2%) were recommended surgical treatment but refused: 18% (95/534) were age ≤40 years. The 5-year overall survival for all patients who refused surgery was significantly decreased compared with patients who underwent surgery (29.2% vs 71.9%, P<0.01). This was demonstrated at ages 41-64 years (65.5% vs 91.0%, P<0.01) and ≥65 years (23.4% vs 75.3%, P<0.01). The 5-year overall survival did not meet statistical significance at age ≤40 years (90.1% vs 87.8% P<0.19). However, there were few patients in this cohort. On multivariate analysis, factors associated with refusal of surgery included: Medicaid insurance, Black race, Hispanic Race, Charlson Comorbidity Index scores of 2 or greater, stage II or III, and if patient received external beam radiation therapy alone. Factors associated with undergoing surgery included: age greater than 41, stage IB, and if the patient received brachytherapy. CONCLUSIONS Refusal of surgery for endometrial cancer is uncommon and leads to decreased overall survival.
References27
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#2Elyse N. Llamocca (OSU: Ohio State University)H-Index: 3
Last. Ashley S. Felix (OSU: Ohio State University)H-Index: 21
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Abstract Background Differences in receipt of guideline-concordant treatment might underlie well-established racial disparities in endometrial cancer mortality. Objective Using the National Cancer Database, we assessed the hypothesis that among women with endometrioid endometrial cancer, racial/ethnic minority women would have lower odds of receiving guideline-concordant treatment than White women. In addition, we hypothesized that lack of guideline-concordant treatment was linked with worse sur...
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#2Kimberly D. Miller (ACS: American Cancer Society)H-Index: 28
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: Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2015, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2016, were collected by the Nati...
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#2Christof Kaltenmeier (University of Pittsburgh)H-Index: 10
Last. Allan Tsung (University of Pittsburgh)H-Index: 73
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Aim To identify factors associated with refusal of surgery in patients with early-stage pancreatic cancer and estimate the impact of this decision on survival.
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#2Alexander Melamed (Harvard University)H-Index: 20
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Abstract Objective To examine temporal trends in treatment and survival among black, Asian, Hispanic, and white women diagnosed with endometrial, ovarian, cervical, and vulvar cancer. Methods Using the National Cancer Database (2004–2014), we identified women diagnosed with endometrial, ovarian, cervical, and vulvar cancer. For each disease site, we analyzed race/ethnicity-specific trends in receipt of evidence-based practices. Professional societies' recommendations were used to define these pr...
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Abstract Objectives Racial disparities exist for endometrial cancer. We examined patterns of care and factors associated with poor outcomes for Black women with endometrial cancer. Methods We studied 110,826 endometrial cancer patients diagnosed between 1980 and 2008 with minimum 5 years follow-up in the Surveillance, Epidemiology, and End Results database. Trends over time in sociodemographics, disease characteristics and treatment factors were analyzed over four eras: 1980–1989, 1990–1999, 200...
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#2Hui LiH-Index: 1
Last. Liping Gu (JLU: Jilin University)H-Index: 1
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Objectives The aim of this study was to investigate the different efficacies of various fertility-preserving therapies for grade 1 presumed stage IA endometrial cancer. Methods We searched the major online databases (PubMed, MEDLINE, Cochrane Library, Web of Science, and Ovid) and retrieved all the research on fertility-preserving treatment for young, grade 1 presumed stage IA endometrial adenocarcinoma patients since January 2000. We used the systemic evaluation of the Cochrane Collaboration to...
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#2Tanja Ignatov (Otto-von-Guericke University Magdeburg)H-Index: 16
Last. Atanas Ignatov (Otto-von-Guericke University Magdeburg)H-Index: 18
view all 5 authors...
Abstract Background Elderly women with endometrial cancer receive less therapy in comparison with their younger counterparts. The exact reason(s) for this treatment strategy remains unclear. Patients and methods We performed a multicenter, retrospective registry-based study of 1550 patients with endometrial cancer. The outcome measure was the reason for not performing the indicated treatment. Results Median follow-up was 76.8months. A total of 1550 women were eligible for analysis: 353 (22.7%) w...
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#2Yongmei Huang (Columbia University)H-Index: 12
Last. Jason D. Wright (Columbia University)H-Index: 72
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Background Uterine-preserving therapy with progesterone may be used in young women with endometrial cancer who desire fertility preservation. Such therapy delays definitive treatment with hysterectomy. Objective We examined the use and safety of progestational therapy in young women with endometrial cancer. The primary outcome of the analysis was overall survival. Study Design We identified women ≤49 years of age with stage I endometrial cancer in the National Cancer Database from 2004 through 2...
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#2Michail Alevizakos (University of Pittsburgh)H-Index: 13
Last. Michail Pitiakoudis (DUTH: Democritus University of Thrace)H-Index: 20
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Abstract Background It has been reported that some patients with breast cancer may refuse cancer-directed surgery, but the incidence in the United States is not currently known. The purpose of this study was to identify the incidence, trends, risk factors, and eventual survival outcomes associated with refusal of recommended breast cancer–directed surgery. Patients A retrospective review of the Surveillance Epidemiology and End Results (SEER) database between 2004 and 2013 was performed. Patient...
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#1Zoë R GreenwaldH-Index: 7
#2Lina N. HuangH-Index: 1
Last. Walter H. GotliebH-Index: 50
view all 5 authors...
BACKGROUND The incidence of endometrial cancer among young women is increasing. Some patients with low-grade endometrial cancer receive hormone therapy (HT) before surgery to preserve fertility. It is unclear whether this adversely affects survival. METHODS Patients with localized, low-grade endometrial cancer who were aged <45 years were selected from the Surveillance, Epidemiology, and End Results database between 1993 and 2012. Propensity score matching was used to select comparable groups re...
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