title: Disparities in the surgical staging of high-grade endometrial cancer in the United States.
abstract: BACKGROUND
  The National Comprehensive Cancer Network (NCCN) and the Society of Gynecologic Oncology (SGO) recommend lymph node sampling (LNS) as a key component in the surgical staging of high-grade endometrial cancer. Our goal was to examine surgical staging patterns for high-grade endometrial cancer in the United States.
  
  
  METHODS
  The National Cancer Data Base (NCDB) was searched for patients who underwent surgery for serous, clear cell, or grade 3 endometrioid endometrial cancer. Outcomes were receipt of LNS and overall survival (OS). Multivariate logistic regression was used to examine receipt of LNS in Stage I-III disease based on race (White vs. Black), income, surgical volume, and distance traveled to care. Multivariate Cox proportional hazards regression modeling was used to assess OS based on stage, race, income, LNS, surgical volume, and distance traveled.
  
  
  RESULTS
  Forty-two thousand nine hundred seventy-three patients were identified: 76% White, 53% insured by Medicare/Medicaid, 24% traveled >30 miles, and 33% stage III disease. LNS was similar among White and Black women (81% vs 82%). LNS was more common among >30 miles traveled (84% vs 81%,p <0.001), higher surgical volume (83% vs 80%,p <0.001), and academic centers (84% vs 80%,p <0.001). In multivariate analysis, higher income, higher surgical volume, Charlson-Deyo score, and distance traveled were predictors of LNS. Stage III disease (HR 3.39, 95% CI 3.28-3.50), age (10-year increase; HR 1.63, 95% CI 1.61-1.66), lack of LNS (HR 1.64, 95% CI 1.56-1.69), and low income (HR 1.20, 95% CI 1.14-1.27) were predictors of lower survival.
  
  
  CONCLUSIONS
  Surgical care for high-grade endometrial cancer in the United States is not uniform. Improved access to high quality care at high volume centers is needed to improve rates of recommended LNS.
authors.affiliation: Division of Gynecologic Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Foote
authors.affiliation: Division of Gynecologic Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Gaillard
authors.affiliation: Biostatistics, Duke Cancer Institute, Duke University, 2301 Erwin Rd, Durham, NC 27710 USA.
authors.forename: Gloria
authors.initials: G
authors.lastname: Broadwater
authors.affiliation: Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA.|Duke Clinical Research Institute, Durham, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
authors.affiliation: Division of Gynecologic Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Davidson
authors.affiliation: Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Adam
authors.affiliation: Division of Gynecologic Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA.
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
authors.affiliation: Division of Gynecologic Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA.
authors.forename: Monica B
authors.initials: MB
authors.lastname: Jones
authors.affiliation: Division of Radiation Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA.
authors.forename: Junzo
authors.initials: J
authors.lastname: Chino
authors.affiliation: Division of Gynecologic Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
keywords: Disparity; Endometrial cancer; High-grade; NCDB; Staging; Surgical volume