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Body mass index and lymph node metastases in endometrial cancer: Can we omit lymphadenectomy in the morbidly obese?
Abstracts / Gynecologic Oncology 133 (2014) 2–207
381 - Poster Session B Human papillomavirus (HPV) genotype prevalence in invasive vaginal cancers from a registry-based United States population A.K. Sinno1,2, M. Saraiya3, T. Thompson3, B. Hernandez4, M.T. Goodman4, W. Cozen5, M. Steinau3, M. Watson3, E. Unger3. 1Johns Hopkins University, Baltimore, MD, USA, 2Emory University, Atlanta, GA, USA, 3Centers for Disease Control and Prevention, Atlanta, GA, USA, 4 University of Hawaii Cancer Center, Honolulu, HI, USA, 5Keck School of Medicine, Los Angeles, CA, USA. Objectives: To describe the HPV genotype distribution in invasive vaginal cancers diagnosed before introduction of the HPV vaccine. Methods: Four population-based registries and three residual tissue repositories provided formalin-fixed, paraffin-embedded (FFPE) tissue from eligible cases diagnosed between 1994 and 2005 that were tested with the linear array (LA) HPV genotyping test. Samples with negative or inadequate LA results were retested with the INNOLiPA HPV genotyping assay. Clinical, demographic, and all-cause survival data were assessed by HPV status. Results: Sixty cases of invasive vaginal cancer were identified. Among the patients, 75% were positive for any HPV. The most frequently detected was HPV16 (55%, 33/60), followed by HPV33 (18.3%, 11/60). Only one case was positive for HPV18 (1.7%). Multiple types were detected in 15% of patients. Those who were b60 years old were more likely than those who were ≥60 years to be HPV16- or HPV18-positive (HPV16/18): 77.3% vs 44.7% (P = 0.038). The median age at diagnosis was younger in the HPV16/18 group (59 years) vs other HPV-positive (68 years) and no HPV (77 years) (P = 0.003). The HPV distribution was not significantly different between race/ethnicity and place of residence. The 5-year unadjusted all-cause survival was 57.4% among vaginal cancers that were HPV-positive vs 35.4% among HPV-negative vaginal cancers. The unadjusted HR comparing HPV-positive to HPV-negative was 0.62 (95% CI 0.28–1.39). However, after adjusting for age, the HR was 1.57 (95% CI 0.63–3.91). Conclusions: In the largest United States case series of invasive vaginal cancer to date, HPV16 and HPV33 and not HPV18 were the most common genotypes observed in cases diagnosed before introduction of the HPV vaccines. Younger women with vaginal cancer were more likely to be HPV-positive. Further studies are needed to clearly elucidate the prognostic effect of HPV in vaginal cancer after controlling for age. doi:10.1016/j.ygyno.2014.03.401
382 - Poster Session B Body mass index and lymph node metastases in endometrial cancer: Can we omit lymphadenectomy in the morbidly obese? S.L. Yanke1, M.M.K. Shahzad1,2, R.J. Chappell1, D.M. Kushner1. 1 University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, 2H. Lee Moffitt Cancer Center, Tampa, FL, USA. Objectives: Pelvic and para-aortic lymphadenectomy is more technically difficult in morbidly obese patients with endometrial cancer. Obese women are more likely to have less aggressive (type I) endometrial cancers. Many specialists, thus, operate under the assumption that these patients have tumors with a lower chance of lymph node metastasis and omit complete lymph node dissection. However, the relationship between obesity and risk of lymph node metastasis has never been fully elucidated. We investigated the impact of body mass index (BMI) on rate of lymph node metastasis in these patients. Methods: Following institutional board review approval, a retrospective chart review was performed on patients who underwent surgical staging of endometrial cancer at a comprehensive cancer center from 2000 to 2010. Data were first obtained from a representative distribution of patients. Based on the initial findings,
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quintiles were determined, and the lowest and highest quintiles of BMI were overrepresented in the remaining patients using a probability-weighted stratified sample. Predictive models for lymph node metastases were fitted using a generalized additive model. Significance defined as P b 0.05. Results: A total of 1750 patients were evaluated during the study period. Data were abstracted from a total of 305 patients (170 most recent patients to determine initial distribution and an additional 135 patients in overrepresented quintiles of BMI). In univariate analysis, BMI was not correlated with an increased risk of lymph node metastasis (P = 0.24). Age, tumor size, myometrial invasion, and lymphovascular space invasion were all correlated with an increased rate of lymph node metastasis. Endometrioid histology was correlated with a decreased rate of lymph node metastasis. In multivariate analyses, BMI did not show any association with rate of lymph node metastasis after controlling for age, tumor size, lymphovascular space invasion, myometrial invasion, and histology (P = 0.63). Conclusions: BMI was not correlated with the rate of lymph node metastasis. Although it is tempting to omit lymph node dissection in the morbidly obese patient (due to technical difficulty and a perceived nonaggressive nature of these tumors), BMI should not be used as a criterion to triage patients with endometrial cancer for lymph node dissection. doi:10.1016/j.ygyno.2014.03.402
383 - Poster Session B Socioeconomic status as a predictor of adherence to treatment guidelines for early-stage ovarian cancer M. Hodeib, R.E. Bristow, L.M. Randall, F. Liu, J. Chang, A. Ziogas, H. Anton-Culver. University of California at Irvine, Orange, CA, USA. Objectives: To investigate the impact of socioeconomic status (SES) and other demographic variables on adherence to National Comprehensive Cancer Center (NCCN) ovarian cancer treatment guidelines among patients with stage I/II disease. Methods: Consecutive patients diagnosed with stage I/II epithelial ovarian cancer between January 1, 1999 and December 31, 2006 were identified from the California Cancer Registry. Univariate analysis and multivariate logistic regression models were used to evaluate for differences in surgical procedures, chemotherapy treatment, and overall care adherence to NCCN guideline care according increasing SES quintile (SES-1 to SES-5), other demographic variables, tumor characteristics, and hospital/physician annual case volume. Results: A total of 5445 patients were identified. The median age at diagnosis was 54.0 years (range, 18–99 years); 72.5% of patients had stage I disease and 27.5% had stage II disease. With a median follow-up time of 4.9 years, the 5-year ovarian cancer-specific survival for all patients was 82.7% (SE = 0.6). Overall, 23.7% of patients received care that was adherent to NCCN guidelines. Compared to patients in SES-5, patients in SES-1 were significantly less likely to receive proper surgery (27.3% vs 47.9%, P b 0.001) and indicated chemotherapy (42.4% vs 53.6%, P b 0.001). There was a linear relationship between increasing SES and the likelihood of overall treatment plan adherence to NCCN guidelines: SES-1 = 16.4%, SES-2 = 19.0%, SES-3 = 22.4%, SES-4 = 24.2%, SES5 = 31.6% (P b 0.001). Binary logistic regression analysis revealed that compared to SES-5, decreasing SES was independently predictive of a higher risk of nonadherent care: SES-4, OR 1.51, 95% CI 1.26–1.81; SES-3, OR 1.55, 95% CI 1.28–1.87; SES-2, OR 1.78, 95% CI, 1.44–2.20; SES-1, OR 2.01, 95% CI 1.55–2.62. Medicaid payer status (OR 1.30, 95% CI 1.04– 1.62), low-volume hospitals (OR 1.58, 95% CI 1.35–1.86), and lowvolume physicians (OR 1.24, 95% CI 1.04–1.48) were also independently associated with an increased risk of overall treatment nonadherence to NCCN guidelines.
381 - Poster Session B Human papillomavirus (HPV) genotype prevalence in invasive vaginal cancers from a registry-based United States population A.K. Sinno1,2, M. Saraiya3, T. Thompson3, B. Hernandez4, M.T. Goodman4, W. Cozen5, M. Steinau3, M. Watson3, E. Unger3. 1Johns Hopkins University, Baltimore, MD, USA, 2Emory University, Atlanta, GA, USA, 3Centers for Disease Control and Prevention, Atlanta, GA, USA, 4 University of Hawaii Cancer Center, Honolulu, HI, USA, 5Keck School of Medicine, Los Angeles, CA, USA. Objectives: To describe the HPV genotype distribution in invasive vaginal cancers diagnosed before introduction of the HPV vaccine. Methods: Four population-based registries and three residual tissue repositories provided formalin-fixed, paraffin-embedded (FFPE) tissue from eligible cases diagnosed between 1994 and 2005 that were tested with the linear array (LA) HPV genotyping test. Samples with negative or inadequate LA results were retested with the INNOLiPA HPV genotyping assay. Clinical, demographic, and all-cause survival data were assessed by HPV status. Results: Sixty cases of invasive vaginal cancer were identified. Among the patients, 75% were positive for any HPV. The most frequently detected was HPV16 (55%, 33/60), followed by HPV33 (18.3%, 11/60). Only one case was positive for HPV18 (1.7%). Multiple types were detected in 15% of patients. Those who were b60 years old were more likely than those who were ≥60 years to be HPV16- or HPV18-positive (HPV16/18): 77.3% vs 44.7% (P = 0.038). The median age at diagnosis was younger in the HPV16/18 group (59 years) vs other HPV-positive (68 years) and no HPV (77 years) (P = 0.003). The HPV distribution was not significantly different between race/ethnicity and place of residence. The 5-year unadjusted all-cause survival was 57.4% among vaginal cancers that were HPV-positive vs 35.4% among HPV-negative vaginal cancers. The unadjusted HR comparing HPV-positive to HPV-negative was 0.62 (95% CI 0.28–1.39). However, after adjusting for age, the HR was 1.57 (95% CI 0.63–3.91). Conclusions: In the largest United States case series of invasive vaginal cancer to date, HPV16 and HPV33 and not HPV18 were the most common genotypes observed in cases diagnosed before introduction of the HPV vaccines. Younger women with vaginal cancer were more likely to be HPV-positive. Further studies are needed to clearly elucidate the prognostic effect of HPV in vaginal cancer after controlling for age. doi:10.1016/j.ygyno.2014.03.401
382 - Poster Session B Body mass index and lymph node metastases in endometrial cancer: Can we omit lymphadenectomy in the morbidly obese? S.L. Yanke1, M.M.K. Shahzad1,2, R.J. Chappell1, D.M. Kushner1. 1 University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, 2H. Lee Moffitt Cancer Center, Tampa, FL, USA. Objectives: Pelvic and para-aortic lymphadenectomy is more technically difficult in morbidly obese patients with endometrial cancer. Obese women are more likely to have less aggressive (type I) endometrial cancers. Many specialists, thus, operate under the assumption that these patients have tumors with a lower chance of lymph node metastasis and omit complete lymph node dissection. However, the relationship between obesity and risk of lymph node metastasis has never been fully elucidated. We investigated the impact of body mass index (BMI) on rate of lymph node metastasis in these patients. Methods: Following institutional board review approval, a retrospective chart review was performed on patients who underwent surgical staging of endometrial cancer at a comprehensive cancer center from 2000 to 2010. Data were first obtained from a representative distribution of patients. Based on the initial findings,
153
quintiles were determined, and the lowest and highest quintiles of BMI were overrepresented in the remaining patients using a probability-weighted stratified sample. Predictive models for lymph node metastases were fitted using a generalized additive model. Significance defined as P b 0.05. Results: A total of 1750 patients were evaluated during the study period. Data were abstracted from a total of 305 patients (170 most recent patients to determine initial distribution and an additional 135 patients in overrepresented quintiles of BMI). In univariate analysis, BMI was not correlated with an increased risk of lymph node metastasis (P = 0.24). Age, tumor size, myometrial invasion, and lymphovascular space invasion were all correlated with an increased rate of lymph node metastasis. Endometrioid histology was correlated with a decreased rate of lymph node metastasis. In multivariate analyses, BMI did not show any association with rate of lymph node metastasis after controlling for age, tumor size, lymphovascular space invasion, myometrial invasion, and histology (P = 0.63). Conclusions: BMI was not correlated with the rate of lymph node metastasis. Although it is tempting to omit lymph node dissection in the morbidly obese patient (due to technical difficulty and a perceived nonaggressive nature of these tumors), BMI should not be used as a criterion to triage patients with endometrial cancer for lymph node dissection. doi:10.1016/j.ygyno.2014.03.402
383 - Poster Session B Socioeconomic status as a predictor of adherence to treatment guidelines for early-stage ovarian cancer M. Hodeib, R.E. Bristow, L.M. Randall, F. Liu, J. Chang, A. Ziogas, H. Anton-Culver. University of California at Irvine, Orange, CA, USA. Objectives: To investigate the impact of socioeconomic status (SES) and other demographic variables on adherence to National Comprehensive Cancer Center (NCCN) ovarian cancer treatment guidelines among patients with stage I/II disease. Methods: Consecutive patients diagnosed with stage I/II epithelial ovarian cancer between January 1, 1999 and December 31, 2006 were identified from the California Cancer Registry. Univariate analysis and multivariate logistic regression models were used to evaluate for differences in surgical procedures, chemotherapy treatment, and overall care adherence to NCCN guideline care according increasing SES quintile (SES-1 to SES-5), other demographic variables, tumor characteristics, and hospital/physician annual case volume. Results: A total of 5445 patients were identified. The median age at diagnosis was 54.0 years (range, 18–99 years); 72.5% of patients had stage I disease and 27.5% had stage II disease. With a median follow-up time of 4.9 years, the 5-year ovarian cancer-specific survival for all patients was 82.7% (SE = 0.6). Overall, 23.7% of patients received care that was adherent to NCCN guidelines. Compared to patients in SES-5, patients in SES-1 were significantly less likely to receive proper surgery (27.3% vs 47.9%, P b 0.001) and indicated chemotherapy (42.4% vs 53.6%, P b 0.001). There was a linear relationship between increasing SES and the likelihood of overall treatment plan adherence to NCCN guidelines: SES-1 = 16.4%, SES-2 = 19.0%, SES-3 = 22.4%, SES-4 = 24.2%, SES5 = 31.6% (P b 0.001). Binary logistic regression analysis revealed that compared to SES-5, decreasing SES was independently predictive of a higher risk of nonadherent care: SES-4, OR 1.51, 95% CI 1.26–1.81; SES-3, OR 1.55, 95% CI 1.28–1.87; SES-2, OR 1.78, 95% CI, 1.44–2.20; SES-1, OR 2.01, 95% CI 1.55–2.62. Medicaid payer status (OR 1.30, 95% CI 1.04– 1.62), low-volume hospitals (OR 1.58, 95% CI 1.35–1.86), and lowvolume physicians (OR 1.24, 95% CI 1.04–1.48) were also independently associated with an increased risk of overall treatment nonadherence to NCCN guidelines.