1. Longer wait times from histopathologic diagnosis of uterine cancer to definitive surgery have a negative impact on overall survival.
Evidence rating level: 2 (Good)
Study Rundown: Uterine cancer, which includes cancers of the myometrium and endometrium, can be definitively treated by hysterectomy. The 5-year survival rates are overall good, approaching 80% for endometrial adenocarcinoma following appropriate treatment. The authors of this study sought to investigate the impact of differences in the application of surgical treatment to women following definitive histopathologic diagnosis. Specifically, they examined the effect of longer wait time on overall survival.
Upon the conclusion of this study, the authors found that longer wait times between definitive diagnosis and therapeutic hysterectomy were a negative prognostic factor. Specifically, patients with wait times more than 12 weeks had significantly reduced overall survival at 5 years compared to patients with wait times less than 6 weeks. Based on these findings, the authors concluded that efforts to reduce wait times for treatment may improve the long-term outcomes in the management of uterine cancer. These results benefit from the large scale of this study and its cohort design. The authors also controlled for comorbidities, previous and multiple cancer diagnoses in their cohort population. Nevertheless, it should be noted that this was a retrospective study, and that there may be other factors involved in the wait times that may have affected overall survival. Furthermore, the authors also found that wait times of less than 2 weeks were also adversely prognostic, thus complicating the interpretation of this study.
Relevant reading: Controversies in the management of endometrial cancer: an update
In-Depth [retrospective cohort]: The study authors enrolled subjects from the Ontario Cancer Registry, including women with confirmed histopathologic diagnosis of uterine cancer between 2000 and 2009, followed by surgery. The final population included 9417 women, 69.9% of whom had endometrioid adenocarcinoma. Wait time between diagnosis and surgery was defined as a continuous variable, with categorical divisions into 0.1 to 2, 2.1 to 6, 6.1 to 12, or more than 12 weeks. The primary outcome measured was overall survival at 5 years following diagnosis. For the categories of wait times, overall survival was 71.1%, 81.8%, 79.5% and 71.9%, respectively. After adjusting for comorbidities, multiple, and previous cancer diagnoses, the authors found that wait times of less than 2 weeks were adversely prognostic for survival, and that patients with wait times of more than 12 weeks had significantly worse survival than those with wait times of 2.1 to 12 weeks (p < 0.001).
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