SLIDE 5 Endometrial Cancer
- Modifiable risk factors
- Obesity
‒ Impacting minimally invasive surgery, efficacy of chemotherapy & radiation
- Diabetes
- Black women were less likely to receive surgery (OR 0.38)
‒ Even after adjusting for age, stage, region, income, comorbidities
- Black women have higher mortality (OR 1.6-2.9) and more high-risk
disease
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Doll et al, Am J Obstet Gynecol, 2017 Modesitt et al, Obstet Gynecol Surv, 2005
Minimally Invasive Surgery & Adjuvant therapy
Endometrium Endoscopic or Laparoscopic, robotic, or converted to
- pen surgery performed for all endometrial cancer, for
all stages [ENDLRC]
96% (n=97/101)
75% Chemotherapy and/or radiation administered to patients with Stage IIIC or IV endometrial cancer [ENDCTRT] 90.5% (n=19/21) 85.5%
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Source: UCSF Cancer Registry & ACS CoC
UCSF 2015 ACS CoC Benchmark
Laparoscopy vs. Laparotomy
- GOG LAP2
- Randomized trial of laparoscopy vs. laparotomy for
comprehensive surgical staging of uterine cancer
- N=2616 (920 lap, 1696 L/S), 1996-2005
78% vs 86% complete staging 23% conversion to open, influenced by age, obesity Median OR time: 3.3 vs. 2.2hrs Median LOS: 3 vs. 4 days Laparoscopy with less pneumonia, ileus
3 year recurrence: 11.3 vs. 10.2% 5-year survival: 89.8% in both groups
Walker et al, J Clin Oncol 2009 Walker et al, J Clin Oncol 2012
Helen Diller Family Comprehensive Cancer Center
Role of Gynecologic Oncologist
- SEER database, linked to Medicare
- n=18,338 Endometrial cancer patients, Stage I-IV,
1991-2002
- Multivariate Analysis for Survival
Chan et al, J Clin Oncol 2011 Hazard Ratio Confidence Interval P-value Age at diagnosis 1.04 (1.04 - 1.05) <0.001 Stage 5.89 (5.16 - 6.72) <0.001 Grade 2.87 (2.52 - 3.28) <0.001 Gynecologic oncologist 0.71 (0.62 - 0.82) 0.001
Helen Diller Family Comprehensive Cancer Center
