Rachel S Mandelbaum1, Ling Chen2, Donna Shoupe3, Richard J Paulson3, Lynda D Roman4, Jason D Wright2, Koji Matsuo5. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA. 2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA. 3. Division of Reproductive, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA. 4. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA. 5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA. Electronic address: koji.matsuo@med.usc.edu.
Abstract
OBJECTIVE: To profile patient characteristics associated with and outcomes of ovarian conservation at the time of hysterectomy in young women with minimal-risk endometrial cancer. METHODS: A population-based retrospective analysis of the Nationwide Inpatient Sample between 2007 and 2015 was performed. Women aged <50 with minimal-risk endometrial cancer who had ovarian conservation (n = 2314) were compared to those who had oophorectomy (n = 8191). A classification-tree model with recursive partitioning analysis was constructed to examine patterns of ovarian conservation. Propensity score matching was performed and length of stay and perioperative complications were compared. Two validation cohorts were also analyzed in a similar fashion (benign gynecologic disease and cervical cancer). RESULTS: There were nine distinct patterns of patient characteristics identified, and ovarian conservation rates ranged from 11.7% (women aged 40-49 who underwent abdominal hysterectomy at an urban teaching hospital) to 60.5% (non-obese women aged <40 with median household income ≥$63,000) (absolute difference, 48.8%, 95% confidence interval 39.9-57.7; P < 0.001). After propensity score matching, ovarian conservation was significantly associated with a decreased likelihood of hospitalization >2 days (relative risk reduction, 16.7%, P < 0.001). Rates of surgical complications were not different between the two groups (8.2% versus 8.3%, P = 0.91). In the benign gynecologic disease and cervical cancer cohorts, ovarian conservation was also associated with decreased length of hospitalization (all, P < 0.05). CONCLUSION: There is substantial variability in the utilization of ovarian conservation in young women with minimal-risk endometrial cancer based on patient, surgical, and hospital factors. Our study suggests that guidelines for ovarian conservation in this population would be helpful for improving patient selection and rates of ovarian conservation.
OBJECTIVE: To profile patient characteristics associated with and outcomes of ovarian conservation at the time of hysterectomy in young women with minimal-risk endometrial cancer. METHODS: A population-based retrospective analysis of the Nationwide Inpatient Sample between 2007 and 2015 was performed. Women aged <50 with minimal-risk endometrial cancer who had ovarian conservation (n = 2314) were compared to those who had oophorectomy (n = 8191). A classification-tree model with recursive partitioning analysis was constructed to examine patterns of ovarian conservation. Propensity score matching was performed and length of stay and perioperative complications were compared. Two validation cohorts were also analyzed in a similar fashion (benign gynecologic disease and cervical cancer). RESULTS: There were nine distinct patterns of patient characteristics identified, and ovarian conservation rates ranged from 11.7% (women aged 40-49 who underwent abdominal hysterectomy at an urban teaching hospital) to 60.5% (non-obesewomen aged <40 with median household income ≥$63,000) (absolute difference, 48.8%, 95% confidence interval 39.9-57.7; P < 0.001). After propensity score matching, ovarian conservation was significantly associated with a decreased likelihood of hospitalization >2 days (relative risk reduction, 16.7%, P < 0.001). Rates of surgical complications were not different between the two groups (8.2% versus 8.3%, P = 0.91). In the benign gynecologic disease and cervical cancer cohorts, ovarian conservation was also associated with decreased length of hospitalization (all, P < 0.05). CONCLUSION: There is substantial variability in the utilization of ovarian conservation in young women with minimal-risk endometrial cancer based on patient, surgical, and hospital factors. Our study suggests that guidelines for ovarian conservation in this population would be helpful for improving patient selection and rates of ovarian conservation.
Authors: Koji Matsuo; James C Cripe; Katherine C Kurnit; Michiko Kaneda; Audrey S Garneau; Gretchen E Glaser; Aaron Nizam; Rachel M Schillinger; Michelle L Kuznicki; Akira Yabuno; Shiori Yanai; Denise M Garofalo; Jiro Suzuki; Jessica D St Laurent; Ting-Tai Yen; Annie Y Liu; Masako Shida; Mamoru Kakuda; Tetsuro Oishi; Shin Nishio; Jenna Z Marcus; Sosuke Adachi; Tetsuji Kurokawa; Malcolm S Ross; Max P Horowitz; Marian S Johnson; Min K Kim; Alexander Melamed; Karime K Machado; Kosuke Yoshihara; Yoshio Yoshida; Takayuki Enomoto; Kimio Ushijima; Shinya Satoh; Yutaka Ueda; Mikio Mikami; Bobbie J Rimel; Rebecca L Stone; Whitfield B Growdon; Aikou Okamoto; Saketh R Guntupalli; Kosei Hasegawa; Mian M K Shahzad; Dwight D Im; Marina Frimer; Bobbie S Gostout; Frederick R Ueland; Shoji Nagao; Pamela T Soliman; Premal H Thaker; Jason D Wright; Lynda D Roman Journal: Gynecol Oncol Date: 2019-08-16 Impact factor: 5.482
Authors: Koji Matsuo; Shinya Matsuzaki; Rachel S Mandelbaum; Kazuhide Matsushima; Maximilian Klar; Brendan H Grubbs; Lynda D Roman; Jason D Wright Journal: Gynecol Oncol Date: 2020-01-22 Impact factor: 5.482
Authors: Koji Matsuo; Shinya Matsuzaki; Rachel S Mandelbaum; Kazuhide Matsushima; Maximilian Klar; Brendan H Grubbs; Lynda D Roman; Jason D Wright Journal: J Surg Oncol Date: 2019-11-19 Impact factor: 3.454
Authors: Koji Matsuo; Erica J Chang; Shinya Matsuzaki; Rachel S Mandelbaum; Kazuhide Matsushima; Brendan H Grubbs; Maximilian Klar; Lynda D Roman; Anil K Sood; Jason D Wright Journal: Gynecol Oncol Date: 2020-05-10 Impact factor: 5.482
Authors: R S Mandelbaum; M B Smith; C J Violette; S Matsuzaki; K Matsushima; M Klar; L D Roman; R J Paulson; K Matsuo Journal: BJOG Date: 2020-03-09 Impact factor: 6.531