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Demographic shifts associated with implementation of evidence-based guidelines for ovarian conservation in patients with endometrioid endometrial cancer
  1. Beryl L Manning-Geist1,
  2. Eric Rios-Doria1,
  3. Emeline M Aviki1,2,
  4. Qin Zhou3,
  5. Alexia Iasonos3,
  6. Nadeem R Abu-Rustum1,2,
  7. Carol L Brown1,2 and
  8. Jennifer J Mueller1,2
  1. 1Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  2. 2Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
  3. 3Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  1. Correspondence to Dr Jennifer J Mueller, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; muellerj{at}mskcc.org

Abstract

Objective In 2018, evidence-based surgical guidelines were introduced to identify appropriate patients with low-grade endometrioid endometrial cancer for ovarian conservation. We sought to identify trends and demographic shifts associated with guideline implementation.

Methods We identified women treated for endometrioid endometrial cancer at our institution from January 2010 to June 2021. Eligibility criteria included age ≤50 years, normal-appearing ovaries on preoperative imaging, no family history of hereditary breast and ovarian cancer syndrome or Lynch syndrome, and no hormone receptor-positive malignancy. Trends in ovarian conservation were examined with the Cochran-Armitage trend test or in a logistic regression model. Associations between ovarian conservation and clinicodemographic factors before and after guideline implementation were compared using Wilcoxon rank-sum and Fisher’s exact tests.

Results Of 420 women ≤50 years of age undergoing surgery for endometrioid endometrial cancer, 355 (85%) met the criteria for ovarian conservation—267 (75%) before and 88 (25%) after guideline implementation. Median patient age was 45 years (range 25–50); 62% were non-Hispanic White, 10% Hispanic White, 8% non-Hispanic Black, 0% Hispanic Black, and 20% Asian. Patients were significantly more likely to choose ovarian conservation after (48%) compared with before guideline implementation (21%) (p<0.001). Pre-guidelines, non-Hispanic White women were less likely to elect for ovarian conservation (12%) compared with non-Hispanic Black, Asian, or Hispanic White women (28%) (p=0.002). Similarly, older women were less likely to elect for ovarian conservation compared with younger women (p<0.001). There were no differences by obesity (p=0.68), marital status (p=0.86), or insurance (p=0.89). Post-guidelines, there were no differences in ovarian conservation between non-Hispanic White women (36%) and non-Hispanic Black, Asian, or Hispanic White women (50%) (p=0.56). Older women were still less likely to elect for ovarian conservationcompared with younger women (p<0.001).

Conclusions After guideline implementation, ovarian conservation increased and uptake disparities across demographic groups decreased.

  • Surgery
  • Uterine Cancer

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors Conceptualization: BLM-G, JJM. Data curation: BLM-G. Formal analysis: QZ, AI. Methodology: BLM-G, JJM. Roles/writing - original draft: BMG. Writing - review & editing: all authors. JJM is responsible for the overall content as the guarantor.

  • Funding This research was funded in part by the NIH/NCI Cancer Center Support Grant P30 CA008748.

  • Competing interests Outside the submitted work, Dr Abu-Rustum reports research funding paid to the institution from GRAIL.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.