Article Text
Abstract
Introduction Textbook Oncologic Outcome (TOO) has emerged as a composite measure to assess quality of care and predict overall survival (OS) in surgical oncology. We aimed to assess the association between TOO and OS in endometrial cancer (EC) surgery.
Methods Patients undergoing surgery for early-stage EC between 2018 and 2020 with FIGO 2009 stage I, II, and IIIC on definitive pathology were identified in the National Cancer Database. The primary outcome was TOO defined as achieving: 1) minimally invasive hysterectomy; 2) adequate lymph node staging; 3) no 30-day hospital readmission; 4) length of hospital stay ≤1 day; 5) appropriate adjuvant therapy (chemotherapy for stage IIIC endometrioid EC and stage ≥IB non-endometrioid EC); 6) 90-day survival. Kaplan-Meier method was used to estimate 5-year OS by TOO status and Cox regression to evaluate the relationship between TOO and death within 5 years.
Results A total of 66,416 patients with a mean (SD) age at diagnosis of 62.9 (10.7) years were included. TOO was achieved (TOO+) in 81.0% of patients. Length of stay >1 day was the most frequent reason for not achieving TOO (TOO-) (figure 1). TOO+ was associated with improved 5-year OS: 90.3% (95% CI, 89.0–91.5) TOO+ and 76.4% (95% CI, 74.7–78.1) TOO- (figure 2). Multivariable analysis showed that TOO+ patients are at lower risk of death within 5 years (HR 0.46, 95% CI 0.43–0.49), after adjusting for facility, patient, and disease factors.
Conclusion/Implications TOO is significantly associated with improved long-term survival and may be a useful quality assessment tool after primary surgery for EC.