Risk factors for future development of endometrial cancer in patients with benign endometrial...
1
213 Risk factors for future development of endometrial cancer in patients with benign endometrial biopsy: Epidemiologic study from the Olmsted County population M. Torres, A. Weaver, W. Cliby, S. Dowdy, F. Abimbola, S. Uccela, B. Gostout, A. Mariani Mayo Clinic, Rochester, MN Objective: Optimal prevention strategies for endometrial cancer (EC) are predicated on our ability to accurately identify individuals at significantly increased risk for this disease. A large number of patients undergo D&C or office endometrial biopsy (EBDC) every year in the United States, mostly to rule out endometrial abnormalities. Unfortunately, information on risk factors for developing EC in patients who had a benign EBDC is lacking. The aim of this study was to identify these risk factors. From the Rochester Epidemiology Project (REP––Olmsted County population), we identified 370 patients with a diagnosis of EC between 1970 and 2008. One hundred twenty (32.5%) of these women had a previous benign EBDC during their lifetime. The timing between the EBCD and EC ranged from 0 to 45 years, with a median of 7.3 years. These 120 patients were matched (2:1) with EC-free controls based on diagnosis on benign EBDC (i.e., hyperpla- sia vs other benign), age, date of the EBDC and available time of follow-up. Atypical hyperplastic cases and matched controls were excluded. Results: Patient weight or body mass index, nulliparous status, personal history of HNPCC-related cancer (HNPCC+), unopposed estrogen therapy, and oral contraceptive use (OC), before or at the time of the benign endometrial biopsy, were all associated with EC at univariate analysis (P <0.05). In a multivariate conditional logistic regression model, OC (OR=0.17, 95% CI=0.09–0.35, P < 0.001) and HNPCC+ (OR = 4.58, 95% CI = 1.37–15.34, P =0.014) were indepen- dently associated with EC. After excluding variables related to medication (like OC), weight (OR = 1.18, 95% CI = 1.03–1.37, P =0.021) and nulliparous status (OR=2.53, 95% CI=1.23–5.15, P =0.011) were independently associated with EC. Conclusions: As many as one-third of patients with EC had a previous benign EBDC. HNPCC+ is the strongest risk factor for developing endometrial cancer after a benign EBDC, while prior or current use of OC is the strongest protective factor. Patient weight and parity status predicted future development of EC as well. A risk prediction model was generated. doi:10.1016/j.ygyno.2010.12.220 214 Risk factors for thromboembolism within the first 30 days of endometrial cancer surgery S. Kumar, K. Podratz, S. Dowdy, J. Bakkum-Gamez, A. Weaver, M. McGree, J. Martin, W. Cliby, A. Mariani Mayo Clinic, Rochester, MN Objective: The aim of this work was to study the risk factors associated with venous thromboembolism (VTE) within 30 days of surgery for endometrial cancer (EC). Data were collected on all patients who underwent endometrial cancer surgery at our institution during the period 1999 to 2008. Confirmed VTE included deep venous thrombosis (DVT) and/or pulmonary embolism (PE) that occurred within 30 days of surgery. A multivariable logistic model was developed using stepwise and backward variable selection methods. Associations were summarized using odds ratios (ORs). P values <0.05 were considered statistically significant. Results: Of the 1358 (96%) patients with sufficient follow-up, 27 (2.0%) had a diagnosis of VTE in the first 30 days after surgery. Of these,10 (37%) had DVT,15 (56%) had PE, and two (7%) had both DVT and PE. Seventy-eight percent with PE had no concomitant DVT on doppler of lower extremities. Sixteen (59%) VTEs occurred between seven and 30 days after surgery. Among the 1358 patients, the prevalence of preoperative, intraoperative, and postoperative VTE prophylaxis in the form of sequential compression device and/or anticoagulation was 7, 64, and 66.4%, respectively. As compared with the non-VTE cohort, the VTE cohort was older (mean age: 69 years vs 64 years, P =0.02), had longer operative time (mean: 195 minutes vs 165 minutes, P =0.03), and had a longer hospital stay (mean: 15 days vs five days, P = 0.001). In addition, the VTE cohort had a significantly higher prevalence (P <0.05 univariately) of the following variables when compared with the non-VTE cohort: advanced stage of disease (FIGO IV: 30% vs 8%), grade 3 tumors (52% vs 29%), lymph node involvement (33% vs 13%), blood loss >500 mL (52% vs 29%), postoperative fever (22% vs 7%), higher operative complexity (26% vs 6%), and diabetes (48% vs 28%). Receiving any preoperative or intraoperative prophylaxis was not significantly associated with development of VTE (P > 0.05). Prior history of DVT did not significantly differ between the groups (15% vs 7%, P =0.12). In a stepwise multivariable model considering preoperative and intrao- perative factors, estimated blood loss (OR=1.9 per a doubling), age (OR = 1.5 per 10-year increase), and diabetes (OR = 2.5) were identified as significant independent predictors of VTE. Conclusions: Pulmonary embolism was more frequent than DVT within a 30-day period after EC surgery. Clinical variables predicting VTE may help in identification of patients requiring extended VTE prophylaxis as the majority of these events occur after seven 7 days of surgery. doi:10.1016/j.ygyno.2010.12.221 215 Secondary cytoreductive surgery for recurrent endometrial cancer C. McCann, L. Bradford, D. Boruta, M. Del Carmen, A. Goodman, W. Growdon, J. Schorge Massachusetts General Hospital/Harvard University, Boston, MA Objective: The purpose of this study was to determine the survival impact of secondary cytoreductive surgery among patients with recurrent endometrial cancer as few studies have addressed this topic. After institutional review board approval, all patients diag- nosed with endometrial cancer recurrence between 1992 and 2009 who underwent cytoreductive surgery were retrospectively identified from the tumor registry database. Demographic, pathologic and clinical data were abstracted from medical records. Survival estimates were calculated using the Kaplan– Meier method. Results: Fifty-one patients with recurrent endometrial cancer under- went secondary cytoreductive surgery. Mean age at initial diagnosis was 62.6 years (range: 41– 81). Primary treatment consisted of abdominal hysterectomy with bilateral salpingo-oopherectomy (94%), pelvic lymphadenectomy (78%) and paraaortic lymphadenect- omy (27%). Twenty-three patients (45%) had disease confined to the uterus, and 24 patients (47%) had disease outside the uterus. Endometrioid histology predominated (57%), followed by serous (24%) and clear cell (14%). Adjuvant treatment consisted of chemotherapy alone (33%), radiation alone (31%), or a combination (14%). Median time to recurrence was 21 months. Common sites S93 ABSTRACTS / Gynecologic Oncology 120 (2011) S2–S133
Transcript of Risk factors for future development of endometrial cancer in patients with benign endometrial...
213Risk factors for future development of endometrial cancer inpatients with benign endometrial biopsy: Epidemiologic studyfrom the Olmsted County populationM. Torres, A. Weaver, W. Cliby, S. Dowdy, F. Abimbola, S. Uccela,B. Gostout, A. MarianiMayo Clinic, Rochester, MN
Objective: Optimal prevention strategies for endometrial cancer (EC)are predicated on our ability to accurately identify individuals atsignificantly increased risk for this disease. A large number of patientsundergo D&C or office endometrial biopsy (EBDC) every year in theUnited States, mostly to rule out endometrial abnormalities.Unfortunately, information on risk factors for developing EC inpatients who had a benign EBDC is lacking. The aim of this study wasto identify these risk factors.
From the Rochester Epidemiology Project (REP––Olmsted Countypopulation), we identified 370 patients with a diagnosis of ECbetween 1970 and 2008. One hundred twenty (32.5%) of thesewomen had a previous benign EBDC during their lifetime. Thetiming between the EBCD and EC ranged from 0 to 45 years, with amedian of 7.3 years. These 120 patients were matched (2:1) withEC-free controls based on diagnosis on benign EBDC (i.e., hyperpla-sia vs other benign), age, date of the EBDC and available time offollow-up. Atypical hyperplastic cases and matched controls wereexcluded.Results: Patient weight or body mass index, nulliparous status,personal history of HNPCC-related cancer (HNPCC+), unopposedestrogen therapy, and oral contraceptive use (OC), before or at thetime of the benign endometrial biopsy, were all associated with EC atunivariate analysis (P<0.05). In a multivariate conditional logisticregression model, OC (OR=0.17, 95% CI=0.09–0.35, P<0.001) andHNPCC+ (OR=4.58, 95% CI=1.37–15.34, P=0.014) were indepen-dently associated with EC. After excluding variables related tomedication (like OC), weight (OR=1.18, 95% CI=1.03–1.37,P=0.021) and nulliparous status (OR=2.53, 95% CI=1.23–5.15,P=0.011) were independently associated with EC.Conclusions: As many as one-third of patients with EC had a previousbenign EBDC. HNPCC+ is the strongest risk factor for developingendometrial cancer after a benign EBDC, while prior or current use ofOC is the strongest protective factor. Patient weight and parity statuspredicted future development of EC as well. A risk prediction modelwas generated.
doi:10.1016/j.ygyno.2010.12.220
214Risk factors for thromboembolism within the first 30 days ofendometrial cancer surgeryS. Kumar, K. Podratz, S. Dowdy, J. Bakkum-Gamez, A. Weaver,M. McGree, J. Martin, W. Cliby, A. MarianiMayo Clinic, Rochester, MN
Objective: The aim of this work was to study the risk factorsassociated with venous thromboembolism (VTE) within 30 days ofsurgery for endometrial cancer (EC).
Data were collected on all patients who underwent endometrialcancer surgery at our institution during the period 1999 to 2008.Confirmed VTE included deep venous thrombosis (DVT) and/orpulmonary embolism (PE) that occurred within 30 days of surgery. Amultivariable logistic model was developed using stepwise andbackward variable selection methods. Associations were summarized
using odds ratios (ORs). P values<0.05 were considered statisticallysignificant.Results: Of the 1358 (96%) patients with sufficient follow-up, 27(2.0%) had a diagnosis of VTE in the first 30 days after surgery. Ofthese, 10 (37%) had DVT, 15 (56%) had PE, and two (7%) had both DVTand PE. Seventy-eight percent with PE had no concomitant DVT ondoppler of lower extremities. Sixteen (59%) VTEs occurred betweenseven and 30 days after surgery. Among the 1358 patients, theprevalence of preoperative, intraoperative, and postoperative VTEprophylaxis in the form of sequential compression device and/oranticoagulation was 7, 64, and 66.4%, respectively. As compared withthe non-VTE cohort, the VTE cohort was older (mean age: 69 years vs64 years, P=0.02), had longer operative time (mean: 195 minutes vs165 minutes, P=0.03), and had a longer hospital stay (mean: 15 daysvs five days, P=0.001). In addition, the VTE cohort had a significantlyhigher prevalence (P<0.05 univariately) of the following variableswhen compared with the non-VTE cohort: advanced stage of disease(FIGO IV: 30% vs 8%), grade 3 tumors (52% vs 29%), lymph nodeinvolvement (33% vs 13%), blood loss >500 mL (52% vs 29%),postoperative fever (22% vs 7%), higher operative complexity (26%vs 6%), and diabetes (48% vs 28%). Receiving any preoperative orintraoperative prophylaxis was not significantly associated withdevelopment of VTE (P>0.05). Prior history of DVT did notsignificantly differ between the groups (15% vs 7%, P=0.12). In astepwise multivariable model considering preoperative and intrao-perative factors, estimated blood loss (OR=1.9 per a doubling), age(OR=1.5 per 10-year increase), and diabetes (OR=2.5) wereidentified as significant independent predictors of VTE.Conclusions: Pulmonary embolism was more frequent than DVTwithin a 30-day period after EC surgery. Clinical variables predictingVTE may help in identification of patients requiring extended VTEprophylaxis as the majority of these events occur after seven 7 days ofsurgery.
doi:10.1016/j.ygyno.2010.12.221
215Secondary cytoreductive surgery for recurrent endometrial cancerC. McCann, L. Bradford, D. Boruta, M. Del Carmen, A. Goodman,W. Growdon, J. SchorgeMassachusetts General Hospital/Harvard University, Boston, MA
Objective: The purpose of this study was to determine the survivalimpact of secondary cytoreductive surgery among patients withrecurrent endometrial cancer as few studies have addressed this topic.
After institutional review board approval, all patients diag-nosed with endometrial cancer recurrence between 1992 and2009 who underwent cytoreductive surgery were retrospectivelyidentified from the tumor registry database. Demographic,pathologic and clinical data were abstracted from medicalrecords. Survival estimates were calculated using the Kaplan–Meier method.Results: Fifty-one patients with recurrent endometrial cancer under-went secondary cytoreductive surgery. Mean age at initial diagnosiswas 62.6 years (range: 41– 81). Primary treatment consisted ofabdominal hysterectomy with bilateral salpingo-oopherectomy(94%), pelvic lymphadenectomy (78%) and paraaortic lymphadenect-omy (27%). Twenty-three patients (45%) had disease confined to theuterus, and 24 patients (47%) had disease outside the uterus.Endometrioid histology predominated (57%), followed by serous(24%) and clear cell (14%). Adjuvant treatment consisted ofchemotherapy alone (33%), radiation alone (31%), or a combination(14%). Median time to recurrence was 21 months. Common sites
S93ABSTRACTS / Gynecologic Oncology 120 (2011) S2–S133
