Patterns of utilization and outcome of ovarian conservation for young women with minimal-risk endometrial cancer

Rachel S Mandelbaum; Ling Chen; Donna Shoupe; Richard J Paulson; Lynda D Roman; Jason D Wright; Koji Matsuo

doi:10.1016/j.ygyno.2019.04.653

Patterns of utilization and outcome of ovarian conservation for young women with minimal-risk endometrial cancer

Gynecol Oncol. 2019 Jul;154(1):45-52. doi: 10.1016/j.ygyno.2019.04.653. Epub 2019 Apr 26.

Authors

Rachel S Mandelbaum¹, Ling Chen², Donna Shoupe³, Richard J Paulson³, Lynda D Roman⁴, Jason D Wright², Koji Matsuo⁵

Affiliations

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.

Keywords: Endometrial cancer; Outcome; Ovarian conservation; Performance; Utility.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Age Factors
Cohort Studies
Endometrial Neoplasms / surgery*
Female
Humans
Hysterectomy
Middle Aged
Organ Sparing Treatments / methods
Organ Sparing Treatments / statistics & numerical data*
Organ Sparing Treatments / trends
Ovariectomy
Ovary / physiology*
Ovary / surgery
Practice Patterns, Physicians' / statistics & numerical data
Practice Patterns, Physicians' / trends
Retrospective Studies
Risk

Grants and funding

P30 CA014089/CA/NCI NIH HHS/United States