Refusal of surgery and survival outcomes in endometrial cancer

Abstract

ObjectivesThe goal of this study was to determine the impact refusal of surgery has on overall survival in patients with endometrial cancer.MethodsFrom 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.ResultsOf 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.ConclusionsRefusal of surgery for endometrial cancer is uncommon and leads to decreased overall survival.

Reproductive Results in Cancer Survivors after Fertility Sparing Management: The Need for the Standardization of Definitions

“…Black women and those with the lowest high school graduation rate were more likely to refuse surgery for gynecological cancer, for example [69]. These observations were confirmed in other studies focusing on patients with endometrial cancer who refused surgical treatment [70,71]. Black (RR 2.9; 95% CI 2.1-4.1) and Hispanic (RR 2.0; 95% CI 1.2-3.1) women were more likely to refuse surgery when compared with White patients [71].…”

Causes of death in endometrial cancer survivors: A Surveillance, Epidemiology, and End Result–based analysis

“…EC is treated primarily by surgery, with clinical risk factors determining whether adjuvant radiotherapy or chemotherapy should be administered 4 . The survival rate for patients with EC who refused surgery was only 29.2% 22 . Lymph node involvement is an important prognostic factor in patients with EC 23 .…”

“… 4 The survival rate for patients with EC who refused surgery was only 29.2%. 22 Lymph node involvement is an important prognostic factor in patients with EC. 23 Our study also found that most patients with lymph node metastasis died of EC.…”

Circular RNA circ_0005667 promotes cisplatin resistance of endometrial carcinoma cells by regulating IGF2BP1 through miR-145-5p

“…In the past few years, the treatment technology of EC has made great progress, especially for patients with early EC, and the 5-year survival rate has been greatly improved [19,20]. However, for advanced EC patients, the survival rate is often reduced due to the existence of chemoresistance [21,22].…”