title: Time interval between endometrial biopsy and surgical staging for type I endometrial cancer: association between tumor characteristics and survival outcome.
abstract: OBJECTIVE
  To examine whether wait time between endometrial biopsy and surgical staging correlates with tumor characteristics and affects survival outcomes in patients with type I endometrial cancer.
  
  
  METHODS
  A retrospective study was conducted to examine patients with grade 1 and 2 endometrioid adenocarcinoma diagnosed by preoperative endometrial biopsy who subsequently underwent hysterectomy-based surgical staging between 2000 and 2013. Patients who received neoadjuvant chemotherapy or hormonal treatment were excluded. Time interval and grade change between endometrial biopsy and hysterectomy were correlated to demographics and survival outcomes.
  
  
  RESULTS
  Median wait time was 57 days (range 1-177 days) among 435 patients. Upgrading of the tumor to grade 3 in the hysterectomy specimen was seen in 4.7% of 321 tumors classified as grade 1 and 18.4% of 114 tumors classified as grade 2 on the endometrial biopsy, respectively. Wait time was not associated with grade change (P>.05). Controlling for age, ethnicity, body habitus, medical comorbidities, CA 125 level, and stage, multivariable analysis revealed that wait time was not associated with survival outcomes (5-year overall survival rates, wait time 1-14, 15-42, 43-84, and 85 days or more; 62.5%, 93.6%, 95.2%, and 100%, respectively, P>.05); however, grade 1 to 3 on the hysterectomy specimen remained as an independent prognosticator associated with decreased survival (5-year overall survival rates, grade 1 to 3 compared with grade change 1 to 1, 82.1% compared with 98.5%, P=.01). Among grade 1 preoperative biopsies, grade 1 to 3 was significantly associated with nonobesity (P=.039) and advanced stage (P=.019).
  
  
  CONCLUSIONS
  Wait time for surgical staging was not associated with decreased survival outcome in patients with type I endometrial cancer.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California; and the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Matsuo
authors.forename: Neisha R
authors.initials: NR
authors.lastname: Opper
authors.forename: Marcia A
authors.initials: MA
authors.lastname: Ciccone
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Garcia
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Tierney
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Baba
authors.forename: Laila I
authors.initials: LI
authors.lastname: Muderspach
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Roman
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D000328:Adult; D001706:Biopsy; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015141:Los Angeles / Q000453:epidemiology; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013997:Time Factors