Influence of gynecologic oncologists on the survival of patients with endometrial cancer.
OBJECTIVE
Despite a lack of evidence for survival benefit, the American College of Obstetrics and Gynecology has recommendations for referral to gynecologic oncologists for the treatment of endometrial cancer. Therefore, we propose to determine the influence of gynecologic oncologists on the treatment and survival of patients with endometrial cancer.


METHODS
Data were obtained from Medicare and Surveillance, Epidemiology, and End Results (SEER) databases from 1988 to 2005. Kaplan-Meier and Cox proportional hazard methods were used for analyses.


RESULTS
Of 18,338 women, 21.4% received care from gynecologic oncologists (group A) while 78.6% were treated by others (group B). Women in group A were older (age > 71 years: 49.6% v 44%; P < .001), had more lymph nodes (> 16) removed (22% v 17%; P < .001), presented with more advanced (stages III to IV) cancers (21.9% v 14.6%; P < .001), had higher-grade tumors (P < .001), and were more likely to receive chemotherapy for advanced disease (22.6% v 12.4%; P < .001). In those with stages II to IV disease, the 5-year disease-specific survival (DSS) of group A was 79% versus 73% in group B (P = .001). Moreover, in advanced-stage (III to IV) disease, group A had 5-year DSS of 72% versus 64% in group B (P < .001). However, no association with DSS was identified in stage I cancers. On multivariable analysis, younger age, early stage, lower grade, and treatment by gynecologic oncologists were independent prognostic factors for improved survival.


CONCLUSIONS
Patients with endometrial cancer treated by gynecologic oncologists were more likely to undergo staging surgery and receive adjuvant chemotherapy for advanced disease. Care provided by gynecologic oncologists improved the survival of those with high-risk cancers.
University of California, San Francisco (UCSF) School of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94143-1702, USA. chanjohn@obgyn.ucsf.edu
John K
JK
Chan
Alexander E
AE
Sherman
Daniel S
DS
Kapp
Ruxi
R
Zhang
Kathryn E
KE
Osann
Larry
L
Maxwell
Lee-May
LM
Chen
Harshal
H
Deshmukh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000592:standards*; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D053208:Kaplan-Meier Estimate; D008495:Medical Oncology / Q000592:standards*; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010819:Physician's Role; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D016016:Proportional Hazards Models; D012016:Reference Values; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D016019:Survival Analysis; D016896:Treatment Outcome