-
[show abstract]
[hide abstract]
ABSTRACT: To characterize the patterns of primary surgical care for ovarian cancer in a statewide population according to annual surgeon and hospital case volume.
The Maryland hospital discharge database was accessed for annual surgeon and hospital ovarian cancer case volume for the time intervals: 1990-1992, 1993-1995, 1996-98, and 1999-2000. Annual surgeon case volume was categorized as low (</=4), intermediate (5-9), or high (>/=10). Annual hospital case volume was categorized as low (</=9), intermediate (10-19), or high (>/=20). Logistic regression models were used to evaluate for significant trends in case volume distribution over time and factors associated with access to high-volume care.
Overall, 2417 cases were performed by 531 surgeons at 49 hospitals. The distribution according to annual surgeon case volume was low (56.3%), intermediate (9.2%), and high (34.5%). Between 1993 and 2000, there was no significant increase in the proportion of cases performed by high-volume surgeons (OR = 1.03, 95% CI = 0.81-1.33, P = 0.79). Access to high-volume surgeons was positively associated with care at high-volume hospitals and negatively associated with residence >/=50 miles from a high-volume hospital. The overall hospital volume case distribution was low (49.6%), intermediate (27.6%), and high (22.8%). There was a statistically significant decrease in access to high-volume hospitals between 1990 and 1998 (OR = 0.39, 95% CI = 0.30-0.50, P < 0.0001).
A large proportion of primary ovarian cancer surgeries are performed by low-volume surgeons at low-volume hospitals. In light of positive volume-outcomes data for malignancies treated with technically complex operative procedures, increased efforts to concentrate the surgical care of women with ovarian cancer are warranted. Condensed abstract. A large proportion of primary ovarian cancer surgeries are performed by low-volume surgeons at low-volume hospitals. In light of positive volume-outcomes data for malignancies treated with technically complex operative procedures, increased efforts to concentrate the surgical care of women with ovarian cancer are warranted.
Gynecologic Oncology 05/2004; 93(2):353-60. · 3.89 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to describe the feasibility, associated morbidity, and efficacy of radical oophorectomy with primary stapled colorectal anastomosis among patients with locally advanced ovarian cancer with contiguous extension to or encasement of the reproductive organs, pelvic peritoneum, cul-de-sac, and sigmoid colon.
Thirty-one consecutive patients undergoing radical oophorectomy as part of an initial maximal surgical effort for International Federation of Obstetrics and Gynecology (FIGO) stage IIIB-IV ovarian cancer were prospectively collected from October 1, 1997 through November 30, 2001. The surgical technique, associated morbidity, and clinical outcomes are described.
The median age was 63 years. All patients had advanced-stage epithelial ovarian cancer: FIGO stage IIIB (6.5%), stage IIIC (64.5%), stage IV (29.0%). Median operating time was 240 minutes (range 165 to 330 minutes), and the median estimated blood loss was 700 mL (range 300 to 2,900 mL). All patients underwent en bloc rectosigmoid colectomy with primary stapled anastomosis without protective intestinal diversion. There was one (3.2%) anastomotic breakdown requiring reoperation and colostomy. Complete clearance of macroscopic pelvic disease was achieved in all cases. Overall, 87.1% of patients were left with optimal (</=1 cm) residual disease and 61.3% were visibly disease free. There were no postoperative deaths, but major and minor postoperative morbidity occurred in 12.9% and 35.5% of patients, respectively. Blood product transfusion was required in 29.0% of cases. Thirty patients received multiagent platinum-based chemotherapy, with a median overall survival time of 39.5 months.
Radical oophorectomy with primary stapled anastomosis is an effective technique for resection of locally advanced ovarian cancer and contributes significantly to a maximal cytoreductive surgical effort. The associated morbidity is acceptable, and protective intestinal diversion appears unnecessary.
Journal of the American College of Surgeons 10/2003; 197(4):565-74. · 4.55 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for identifying ovarian cancer tumor masses > or =1 cm in patients with clinically occult recurrent disease by conventional CT imaging.
Twenty-two patients with epithelial ovarian cancer, rising serum CA125 levels, and negative or equivocal conventional CT imaging > or =6 months after primary therapy underwent combined PET/CT imaging followed by surgical reassessment. Fisher's exact test was used to measure the ability of PET/CT to predict macroscopic disease > or =1 cm.
The median patient age was 55 years, and 91% of patients had FIGO Stage IIIC/IV disease. The median increase in serum CA125 was 24 U/ml (range 10 to 330 U/ml). Conventional CT was reported as negative (n = 15) or equivocal (n = 7) in all cases. Eighteen patients were ultimately found to harbor recurrent ovarian cancer measuring > or =1 cm at the time of surgery, with a median maximal tumor diameter of 2.3 cm (range 1.5 to 3.2 cm). The overall patient-based accuracy of PET/CT in detecting recurrent disease > or =1 cm was 81.8%, with a sensitivity of 83.3% and positive predictive value of 93.8% (P = 0.046). Of patients with recurrent ovarian cancer > or =1 cm, complete cytoreduction to no gross residual tumor was accomplished in 72.2%.
PET/CT imaging demonstrates high sensitivity and positive predictive value in identifying potentially resectable, macroscopic recurrent ovarian cancer among patients with biochemical evidence of recurrence and negative or equivocal conventional CT findings. In appropriately selected patients, early identification of macroscopic recurrent disease may facilitate complete surgical cytoreduction.
Gynecologic Oncology 10/2003; 90(3):519-28. · 3.89 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Multiple epidemiologic and histologic studies have suggested that ovarian endometriosis can give rise to malignant ovarian tumors, primarily those of epithelial origin. The progression of endometriosis to endometriosis-associated ovarian carcinoma (EAOC) has not been investigated thoroughly and is poorly understood at best. Using immunohistochemical methods, we compared the differential expression patterns of various cytokines and growth factors in atypical endometriosis (AE) and EAOC.
Using the Johns Hopkins Pathology Data Bank, tissue blocks from patients diagnosed with EAOC or AE were identified. Tissue blocks were stained for 4 markers: vascular endothelial growth factor (VEGF), Ki-67, estrogen receptor (ER), and progesterone receptor (PR).
Seventeen cases of EAOC and 8 cases of AE were identified. Staining for VEGF was documented in 16 of 17 (94%) EAOC tissue blocks and in only 1 of 8 (12.5%) AE tissue blocks (P < 0.0001). Only 4 of the 17 (23%) EAOC tissue blocks exhibited positive staining for ER, compared with 8 of 8 (100%) AE tissue blocks (P = 0.0005). Positive staining for PR was noted in only 6 of 17 (35%) EAOC samples but was present in 8 of 8 (100%) AE samples (P = 0.003). Seventy percent of EAOC samples exhibited positive staining for Ki-67, compared with 37.5% of AE samples (P = 0.19).
EAOC appears to be associated with overexpression of VEGF and reduced expression of both ER and PR. Variations in VEGF expression may be associated with the malignant transformation of endometriosis and may present both diagnostic and therapeutic options for the treatment of ovarian malignancies.
Cancer 10/2003; 98(8):1658-63. · 4.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Objective. The aim of this study was to evaluate patterns of care for women with Stage 1A1 and 1A2 cervical cancer utilizing the SEER database.Methods. Review of SEER data from 11 registries from 1990 to 1995 was performed. Data from 2358 women were reviewed and stratified by substage, ethnicity, type of therapy, and age.Results. Three remarkable differences among subgroups were identified. (1) Among women ≥35 years of age, whites were more likely to have Stage 1A1 cancer than blacks or Hispanics; OR (95% CI) = 1.56 (1.05, 2.31) and 1.41 (1.04, 1.91), respectively. (2) Patients ≥35 years of age were more likely to undergo hysterectomy than younger patients both for 1A1 and 1A2 stages; OR (95% CI) = 2.31 (1.68, 3.19) and 2.78 (2.21, 3.50), respectively, with Mantel–Haenszel test of independence χ2 = 102.9943, P value < 0.001. (3) Black and Hispanic women ≥35 years of age with 1A2 disease were less likely to have a hysterectomy than whites. Only 15% of Hispanic patients and 9% of blacks over the age of 35 and with Stage 1A2 were treated via hysterectomy, compared to 76% of white women. Differences in hysterectomies for <35 years of age, 1A1 patients approached but did not reach statistical significance: blacks 36% versus Hispanic/whites 59%, P value = 0.07.Conclusions. Older white women were more likely to have cervical carcinoma diagnosed at an earlier stage (1A1) than age-matched blacks or Hispanics. Older patients, across all ethnic groups analyzed, were also more likely to be treated for both Stage 1A1 and 1A2 disease via hysterectomy than younger patients. Ethnic differences in the management of women with Stage 1A2 cervical cancer do exist: older minority women are less likely to have a hysterectomy and more likely to be treated via fertility-sparing, less definitive procedures than whites.
Gynecologic Oncology.
