title: Does oncologic specialization influence outcomes following surgery in early stage adenocarcinoma of the endometrium?
abstract: OBJECTIVE
  To evaluate treatment outcomes in women with early-stage endometrial cancer (FIGO IA, IB, IC, or IIA) surgically managed by a general gynecologist (GYN) or a gynecologic oncologist (GYO).
  
  
  RESULTS
  349 women treated from 1990-2003 were studied. Median follow-up was 3.7 years. Ninety-five were classified as high-intermediate risk (HIR: stages IB grade III, IC grade II or III, any stage IIA). 110 women received adjuvant radiotherapy. The GYO group had more unfavorable tumor characteristics based on stage and grade (P<0.0001), shorter follow-up (median 3.1 vs. 5.1 years, P=0.0002), and an absolute 12% less likelihood of receiving adjuvant radiotherapy (P=0.04). Local and distant failures were not significantly different. Overall survival favored GYN patients (P=0.02) with no difference in disease-specific survival (P=0.38). Multivariate analysis for disease-free survival revealed HIR disease (P=0.04) and GYO treatment (P=0.049) to be significant, with a trend for age<or=64 (P=0.05). Multivariate analysis for overall survival found age<or=64 (P=0.0001), HIR disease (P=0.01), and adjuvant radiotherapy (P=0.0055) to be significant.
  
  
  CONCLUSIONS
  Women primarily managed by a GYO for early-stage disease were significantly less likely to receive adjuvant radiotherapy. Despite significantly more unfavorable disease characteristics among GYO-managed women, disease-free and cause-specific survival were equivalent between the two groups. Favorable disease characteristics and adjuvant radiotherapy correlated with improved survival on multivariate analysis.
authors.affiliation: Department of Radiation Oncology, Huntsman Cancer Hospital at the University of Utah, 1950 Circle of Hope, Salt Lake City, UT 84112-5560, USA.
authors.forename: O Kenneth
authors.initials: OK
authors.lastname: Macdonald
authors.forename: William T
authors.initials: WT
authors.lastname: Sause
authors.forename: R Jeffery
authors.initials: RJ
authors.lastname: Lee
authors.forename: Mark K
authors.initials: MK
authors.lastname: Dodson
authors.forename: Karen
authors.initials: K
authors.lastname: Zempolich
authors.forename: David K
authors.initials: DK
authors.lastname: Gaffney
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000592:standards; D006176:Gynecology; D006801:Humans; D008495:Medical Oncology; D008875:Middle Aged; D009367:Neoplasm Staging; D013043:Specialties, Surgical; D016896:Treatment Outcome