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  • 1
    In: International Journal of Gynecologic Cancer, BMJ, Vol. 30, No. 9 ( 2020-09), p. 1347-1355
    Abstract: A recent randomized clinical trial showed that minimally invasive surgery led to poorer survival compared with open surgery in early stage cervical cancer. We determined the trends in adoption of minimally invasive surgery and 5-year overall survival outcomes after open, laparoscopic-assisted, and robotic-assisted hysterectomy for stage II uterine cancer with cervical stromal involvement. Methods Data for patients with stage II uterine cancer were acquired from the National Cancer Database from 2010 to 2015. χ 2 testing, Kaplan–Meier methods, and Cox models were used for statistical analyses. Results Of 2949 patients, 44.3% underwent open hysterectomy, 13.9% underwent laparoscopic hysterectomy, and 41.8% underwent robotic hysterectomy. The proportion of robotic cases increased from 26.8% in 2010 to 48.3% in 2015 (annual percent change 10.1%), with a decrease in open hysterectomy from 63.3% to 34.3% (annual percent change –12.5%). The overall 5-year survival was 77.6% in robotic, 76.8% in laparoscopic, and 72.5% in open hysterectomy (p=0.045); however, after adjusting for known prognostic factors, robotic (HR 1.00, 95% CI 0.82 to 1.21; p=0.97) and laparoscopic hysterectomy (HR 1.09, 95% CI 0.83 to 1.44; p=0.54) did not portend for improved survival compared with open hysterectomy. Black women (HR 1.59, 95% CI 1.25 to 2.02; p 〈 0.001) and individuals with co-morbidities (HR 1.45, 95% CI 1.21 to 1.75, p 〈 0.001) had worse adjusted survival and the highest rates of open hysterectomy. Conclusion The use of minimally invasive surgery for stage II uterine cancer has increased over time, with comparable adjusted 5-year survival after robotic or laparoscopic hysterectomy compared with open hysterectomy. Black women and those with co-morbidities had lowest rates of minimally invasive surgery and the poorest adjusted survival.
    Type of Medium: Online Resource
    ISSN: 1048-891X , 1525-1438
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2009072-9
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  • 2
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    Online Resource
    Elsevier BV ; 2020
    In:  American Journal of Obstetrics and Gynecology Vol. 222, No. 2 ( 2020-02), p. 170.e1-170.e11
    In: American Journal of Obstetrics and Gynecology, Elsevier BV, Vol. 222, No. 2 ( 2020-02), p. 170.e1-170.e11
    Type of Medium: Online Resource
    ISSN: 0002-9378
    RVK:
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2003357-6
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  • 3
    In: Gynecologic Oncology, Elsevier BV, Vol. 161, No. 2 ( 2021-05), p. 470-476
    Type of Medium: Online Resource
    ISSN: 0090-8258
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
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  • 4
    In: International Journal of Gynecologic Cancer, BMJ, Vol. 31, No. 2 ( 2021-02), p. 194-202
    Abstract: Gestational trophoblastic neoplasia are a group of diseases with few data given their rarity. The aim of this study was to determine the age and racial differences in the presentation and survival of patients with gestational trophoblastic neoplasia in the United States. Methods Data were collected from the National Cancer Database from January 2004 to December 2014. Chi-square tests, Cox regression, and Kaplan–Meier models were performed. Demographic characteristics included age at diagnosis, race, insurance status, facility location and type, community median income, high school dropout rate, education, income, and population density data. Results There were 1004 eligible patients including 64% white (n=645), 23% black (n=233), and 8.3% Asian patients (n=83). Median age was 30.8 (range 14–59) years. Stage I, II, III, IV, and unknown were diagnosed in 32%, 5.4%, 30%, 18%, and 15% of patients, respectively, with 5-year survival of 99%, 93%, 94%, 72%, and 95%, respectively (p 〈 0.001). Compared with national birth rates, those with gestational trophoblastic neoplasia were overrepresented at younger (age 10–19 years: 8.2% vs 4.8%) and older ages (age 40–54 years: 17% vs 3.3%). The extremes of age at presentation were more pronounced in black patients with gestational trophoblastic neoplasia (age 10–19 years: 11% vs 6.9%, 40–54 years: 18% vs 3.2%), and black patients constituted 23% of patients compared with 15% of births nationwide. Some 59% of patients were treated at Academic/Research Programs. Only 6/448 (1.3%) facilities treated more than one patient per year, and only 9% (n=92) of patients were treated at one of these high-volume facilities. On multivariable analysis, older age, higher Charlson/Deyo co-morbidity score, and higher stage disease were independently associated with worse survival (all p 〈 0.001). Conclusions Gestational trophoblastic neoplasia was disproportionately higher in those at extremes of age and in black women as compared with United States national data. The lack of centralization of care justifies the need to develop regional centers of excellence for this rare malignancy.
    Type of Medium: Online Resource
    ISSN: 1048-891X , 1525-1438
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2009072-9
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  • 5
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    BMJ ; 2020
    In:  International Journal of Gynecologic Cancer Vol. 30, No. 12 ( 2020-12), p. 1922-1927
    In: International Journal of Gynecologic Cancer, BMJ, Vol. 30, No. 12 ( 2020-12), p. 1922-1927
    Abstract: To evaluate the influence of marital status and other demographic factors on survival of patients with ovarian cancer. Study design Data were obtained from the Surveillance, Epidemiology, and End Results database from 2010 to 2015. Analyses were performed using Kaplan–Meier and multivariate Cox proportional hazard methods. Results Of 19 643 patients with ovarian cancer (median age 60 years, range 18–99), 16 278 (83%), 1381 (7%), 1856 (9%), and 128 (1%) were White, Black, Asian, and Native American, respectively. The majority of patients (10 769, 55%) were married while 4155 (21%) were single, 2278 (12%) were divorced, and 2441 (12%) were widowed. Patients were more likely to be married if they were Asian (65%) or White (56%) than if they were Black (31%) or Native American (39%) (p 〈 0.001). Most married patients were insured (n=9760 (91%), non-Medicaid) compared with 3002 (72%) of single, 1777 (78%) divorced, and 2102 (86%) of widowed patients (p 〈 0.001). Married patients were more likely to receive chemotherapy than single, divorced, and widowed patients (8515 (79%) vs 3000 (72%), 1747 (77%), and 1650 (68%), respectively; p 〈 0.001). The 5-year disease-specific survival of the overall group was 58%. Married patients had improved survival of 60% compared with divorced (52%) and widowed (44%) patients (p 〈 0.001). On multivariate analysis, older age (HR 1.02, 95% CI 1.016 to 1.021, p 〈 0.001), Black race (HR 1.24, 95% CI 1.11 to 1.38, p 〈 0.001), and Medicaid (HR 1.19, 95% CI 1.09 to 1.30, p 〈 0.001) or uninsured status (HR 1.23, 95% CI 1.05 to 1.44, p 〈 0.01) carried a worse prognosis. Single (HR 1.17, 95% CI 1.08 to 1.26, p 〈 0.001), divorced (HR 1.14, 95% CI 1.04 to 1.25, p 〈 0.01), and widowed (HR 1.16, 95% CI 1.06 to 1.26, p 〈 0.001) patients had decreased survival. Conclusion Married patients with ovarian cancer were more likely to undergo chemotherapy with better survival rates. Black, uninsured, or patients with Medicaid insurance had poorer outcomes.
    Type of Medium: Online Resource
    ISSN: 1048-891X , 1525-1438
    Language: English
    Publisher: BMJ
    Publication Date: 2020
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  • 6
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    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2022
    In:  Journal of Clinical Oncology Vol. 40, No. 16_suppl ( 2022-06-01), p. 10534-10534
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 40, No. 16_suppl ( 2022-06-01), p. 10534-10534
    Abstract: 10534 Background: To evaluate trends of HPV-associated oropharyngeal cancers and HPV infections in the United States. Methods: Data was extracted from the United States Cancer Statistics Public Use Database (USCS) between 2001 and 2017 and the National Health and Nutrition Examination Survey (NHANES) between 2011 to 2016. Data on oropharyngeal squamous cell carcinoma (OSCC) was obtained from the USCS database. HPV vaccination and screening (oral washings) data were obtained from NHANES. Based on CDC guidelines, HPV strains were further subdivided into high-risk strains (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68). Results: Based on USCS, oropharyngeal cancer incidence rates have increased in males by 1.64% every year (p 〈 0.001) while remaining stable in females over the last 17 years. Oropharyngeal cancers have increased for all age groups over the age of 55, with the largest increase seen in those between the ages of 65-69 years old (p 〈 0.001). However, individuals between the ages of 30-34 had the largest decrease in oropharyngeal cancers over the same time period (p = 0.016). Based on race, Whites had the highest incidence rates at 5.12/100,000 followed by 2.99 in Blacks, 2.32 in Hispanics, and 1.11 in Asians. By geographical region, the incidence was found to be the highest in the Midwest with 4.68/100,000 and the lowest in the West at 3.78. Our intersectional analysis showed that White males in the South aged 65-69 had the highest incidence of oropharyngeal cancers at 40.57/100,000 and this same group aged 60-64 had the highest annual increase at 4.65% (p 〈 0.001). Using the NHANES database, we showed that those with greater than 4 lifetime sexual partners have a 3-fold higher risk of high risk HPV infection compared to those with 4 or under (7.1% vs 1.9%, p 〈 0.0001). 8.8% of current smokers are infected with high risk oral HPV compared to only 3.9% of non smokers (p 〈 0.001). The incidence of any HPV infection for those 〈 39 years old was 5.9% in 2011 and 4.7% in 2016 (p = 0.4723). In contrast, the incidence in those 〉 39 years old was 6.6% in 2011 and 6.4% in 2016 (p = 0.99). On multivariate analysis, males have a 4-fold higher risk of high risk HPV infections compared to females (4.45, 95% CI: 2.94 - 6.74, p 〈 0.0001). Those with five or more sexual partners have 7-fold higher rate of high risk oral HPV infections compared to those without any sexual partners (7.15, 95% CI: 1.94 - 26.3, p = 0.0039). Furthermore, current smokers (1.81, 95% CI: 1.17 - 2.77, p = 0.0081) and three to four drinks per day (1.63, 95% CI: 1.05 - 2.55, p = 0.0312) have an increased risk of high risk oral HPV infections. Conclusions: Over the last 18 years, oropharyngeal cancers are increasing in individuals over the age of 55, particularly White males residing in the South. Individuals with greater than 4 lifetime sexual partners, current smokers, and those who consume three to four drinks per day have increased HPV infectivity rates.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2022
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  • 7
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 15_suppl ( 2019-05-20), p. e17056-e17056
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 15_suppl ( 2019-05-20), p. e17056-e17056
    Abstract: e17056 Background: To evaluate the influence of marital status, socioeconomic status, and race on the survival of ovarian cancer patients. Methods: Data were obtained from the SEER database from 2010 to 2015. Analyses were performed with Kaplan–Meier and multivariate Cox proportional hazard models. Results: Of 19,772 patients with ovarian cancer (median age: 60), 82.8%, 7.1%, 9.4%, and 0.7% were White, Black, Asian, and Native American, respectively. 54.5%, 21.7%, 11.5%, and 12.3% were married, single, divorced, and widowed. Married patients were older than single patients but younger than divorced and widowed patients (59 vs. 54 vs. 61 vs. 75 years; p 〈 0.001). 55.5%, 30.7%, 64.1%, and 38.8% of White, Black, Asian, and Native American patients were married (p 〈 0.001). 90.6% of married patients were insured compared to 71.8% single, 78% divorced, and 86.1% widowed (p 〈 0.001). Patients who were married presented at earlier clinical stages (I-II) and lower tumor grades (I-II) compared to widowed and divorced patients (p 〈 0.001). Married patients were more likely to receive chemotherapy compared to single, divorced, and widowed patients (79.1% vs. 71.3% vs. 76.7% vs. 67.6%; p 〈 0.001). The 5-year disease-specific survival (DSS) of the overall group was 60.1%. Married patients had similar DSS compared to single patients at 62.3% vs. 65.0%, but improved survival vs 53.7% divorced and 46.6% widowed (p 〈 0.001). In multivariate analysis, patients with stage II-IV or grade III-IV disease, older age (HR: 1.002, 95% CI: 1.001 to 1.003, p 〈 0.01), Medicaid (HR:1.16, 95% CI: 1.11-1.22 p 〈 0.0001) or no insurance (HR:1.20, 95% CI: 1.11-1.30, p 〈 0.0001) had worse prognosis. Married patients had improved survival relative to widowed patients (widowed HR = 1.08; 95% CI: 1.03-1.14; p 〈 0.01). Race did not influence DSS when controlling for surgery, chemotherapy, and radiation. Conclusions: Married patients were younger, had less advanced diseases relative to divorced and widowed patients, and were more likely to receive adjuvant chemotherapy compared to unmarried patients. Marital status is an independent predictor for survival relative to widowed status. DSS among races was not significant.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
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  • 8
    In: Gynecologic Oncology, Elsevier BV, Vol. 159, No. 1 ( 2020-10), p. 118-128
    Type of Medium: Online Resource
    ISSN: 0090-8258
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
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  • 9
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2020
    In:  Journal of Clinical Oncology Vol. 38, No. 15_suppl ( 2020-05-20), p. e18056-e18056
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 38, No. 15_suppl ( 2020-05-20), p. e18056-e18056
    Abstract: e18056 Background: We proposed to determine the incidence and presentation of sex cord stromal and germ cell ovarian cancers in various racial groups. Methods: Data was obtained from the United States Cancer Statistics (USCS) and National Cancer Database (NCDB) databases between 2004 and 2016. Chi-squared tests were used for statistical analyses. Results: Of 8,917 women, 48.2% were diagnosed with sex cord stromal ovarian cancer, and 52.5% had germ cell ovarian cancer. White, Black, and Asian individuals comprised 72.5%, 19.8%, and 4.16% of the population, respectively. Of the sex cord stromal tumors, 84.1% were granulosa cell, 7.9% sertoli leydig, 1.8% steroid cell, and 6.2% "other" tumors. Of the germ cell tumors, 23.3% were immature teratoma, 19.6% dysgerminoma, 10.3% yolk sac, 8.3% mixed germ cell tumor, 0.1% embryonal carcinoma, and 38.3% "other" germ cell tumor histologies. Using the UCSC database, the age-adjusted incidence of sex cord stromal was 0.50 per 100,000 for Blacks compared to 0.23 for Whites and 0.14 for Asians. The incidence for germ cell tumors was 0.40 per 100,000 in Whites, 0.46 in Blacks, and 0.44 in Asians. Using NCDB data, the proportion of sex cord stromal tumor was 5.6% in Blacks compared to 1.5% in Whites and 1.55% in Asians, and the most common histology of sex cord stromal tumors was granulosa cell tumors in every racial group. The proportion of germ cell tumors was also higher in Blacks at 4.4% compared to 2.0% in Whites and 3.9% in Asians. Of germ cell tumors, the most common histology was dysgerminoma for Whites at 22.3% and immature teratoma in Blacks and Asians at 28.0% and 26.9%, respectively. Conclusions: Our data suggest that Black women are more likely to be diagnosed with sex cord stromal tumors compared to White and Asian women. Black and Asian women also had more germ cell cancer than White women.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2020
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  • 10
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    Online Resource
    Elsevier BV ; 2020
    In:  American Journal of Obstetrics and Gynecology Vol. 222, No. 4 ( 2020-04), p. 383-384
    In: American Journal of Obstetrics and Gynecology, Elsevier BV, Vol. 222, No. 4 ( 2020-04), p. 383-384
    Type of Medium: Online Resource
    ISSN: 0002-9378
    RVK:
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2003357-6
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