TY - JOUR
T1 - Survival after pelvic exenteration for uterine malignancy
T2 - A National Cancer Data Base study
AU - Seagle, Brandon Luke L.
AU - Dayno, Megan
AU - Strohl, Anna E.
AU - Graves, Stephen
AU - Nieves-Neira, Wilberto
AU - Shahabi, Shohreh
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016
Y1 - 2016
N2 - Objective To determine overall survival (OS) and factors associated with OS after pelvic exenteration for uterine cancer. Methods Women with uterine cancer who underwent exenteration (n = 1160) were identified from the 1998–2011 National Cancer Data Base. Kaplan-Meier and multivariate Cox proportional-hazards survival analyses were performed to test for associations of potential explanatory variables with OS. Analyzed confounders included age, comorbidity score, insurance status, income, distance from home to treatment center, stage, distant and nodal metastasis, tumor size, surgical margin status, exenteration type, and treatment with radiation and/or chemotherapy. Results Among women with follow-up data (n = 652), median (IQR) OS was 63.1 (42.2–107.2) and 17.6 (14.7–23.9) months for women with node-negative versus node-positive disease, respectively. Histology (p = 1.5 × 10− 4), grade (p = 7.9 × 10− 14), race (p = 0.0002), lymph node status (p = 1.0 × 10− 14), surgical node evaluation (p = 2.8 × 10− 8), surgery for distant metastasis (p = 0.004), distant metastasis at diagnosis (p = 1.3 × 10− 10), positive surgical margins (p = 1.6 × 10− 9), radiotherapy (p = 0.004), and insurance status (p = 6.5 × 10− 6) were significantly associated with differential, unadjusted Kaplan-Meier OS estimates. Exenteration type was not associated with OS (p = 0.357). By multivariate regression, increased age, positive surgical margins, nodal metastasis or unknown nodal status, higher histologic grade, and black race were associated with increased hazards for death. Conclusion Exenteration may be curative for well-selected women with uterine cancer, particularly among women with pathologically negative lymph nodes.
AB - Objective To determine overall survival (OS) and factors associated with OS after pelvic exenteration for uterine cancer. Methods Women with uterine cancer who underwent exenteration (n = 1160) were identified from the 1998–2011 National Cancer Data Base. Kaplan-Meier and multivariate Cox proportional-hazards survival analyses were performed to test for associations of potential explanatory variables with OS. Analyzed confounders included age, comorbidity score, insurance status, income, distance from home to treatment center, stage, distant and nodal metastasis, tumor size, surgical margin status, exenteration type, and treatment with radiation and/or chemotherapy. Results Among women with follow-up data (n = 652), median (IQR) OS was 63.1 (42.2–107.2) and 17.6 (14.7–23.9) months for women with node-negative versus node-positive disease, respectively. Histology (p = 1.5 × 10− 4), grade (p = 7.9 × 10− 14), race (p = 0.0002), lymph node status (p = 1.0 × 10− 14), surgical node evaluation (p = 2.8 × 10− 8), surgery for distant metastasis (p = 0.004), distant metastasis at diagnosis (p = 1.3 × 10− 10), positive surgical margins (p = 1.6 × 10− 9), radiotherapy (p = 0.004), and insurance status (p = 6.5 × 10− 6) were significantly associated with differential, unadjusted Kaplan-Meier OS estimates. Exenteration type was not associated with OS (p = 0.357). By multivariate regression, increased age, positive surgical margins, nodal metastasis or unknown nodal status, higher histologic grade, and black race were associated with increased hazards for death. Conclusion Exenteration may be curative for well-selected women with uterine cancer, particularly among women with pathologically negative lymph nodes.
KW - Exenteration
KW - Prognosis
KW - Survival
KW - Uterine neoplasms
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U2 - 10.1016/j.ygyno.2016.10.018
DO - 10.1016/j.ygyno.2016.10.018
M3 - Article
C2 - 27760707
AN - SCOPUS:84994417733
VL - 143
SP - 472
EP - 478
JO - Gynecologic Oncology
JF - Gynecologic Oncology
SN - 0090-8258
IS - 3
ER -