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Risk factors for Clostridium difficile infection in patients undergoing treatment for gynecologic cancer
Abstracts / Gynecologic Oncology 141 (2016) 2–208
336 – Poster Risk factors for Clostridium difficile infection in patients undergoing treatment for gynecologic cancer E.A. Blakea, J. Sheederb, A.R. Carrubbaa, T. Oklanda, M. Hopkinsc, D.W. Doob, S.R. Guntupallib. aUniversity of Colorado, Denver, Denver, CO, USA, bUniversity of Colorado Denver, Aurora, CO, USA, cUniversity of Colorado School of Medicine, Aurora, CO, USA
OF
Objectives: Clostridium difficile–associated diarrhea (CDAD) is a common and potentially dangerous complication of treatment for gynecologic cancers and is an important metric for quality of hospital care. We sought to evaluate risk factors associated with CDAD specific to gynecologic oncology patients. Methods: In this retrospective review, all inpatient admissions to the gynecologic oncology unit of a tertiary referral center over a 4-year period were abstracted. Demographic, surgical, and medical comorbidities as well as medication use was obtained. Both surgical and medical admissions were included. Diagnosis of CDAD was only made when a positive result was confirmed with polymerase chain reaction (PCR). Standard statistical tests were used. Results: A total of 728 women were included in the analysis. Cancer diagnoses included cervical (11.0%), uterine/endometrial (32.1%), ovarian/fallopian tube/primary peritoneal (53.3%), and vulvar/vaginal (3.5%). Fifteen patients had positive PCR-proven CDAD (2.01%). In bivariate analysis, radiation treatment, surgical admission, nasogastric tube use, corticosteroid/total parenteral nutrition use, H2 blockers/proton-pump inhibitors, age, and primary disease location were not associated with CDAD. Cephalosporin use was associated with decreased risk of CDAD (55% vs 20% in those receiving cephalosporin; OR 0.21, 95% CI 0.06–0.74). Notably, platinum-based chemotherapy use (19% vs 47% in those who received a platinum agent; OR 3.61, 95% CI 1.29–10.13) and early stage (29% vs 60% with stage I-II disease; OR 3.59, 95% CI 1.26–10.21) were associated with increased risk of CDAD. In logistic regression analysis, platinum agents (aOR 5.7, 95% CI 1.91–17.10), early-stage disease (aOR 5.7, 95% CI 1.22–11.05), and cephalosporins (aOR 0.20, 95% CI 0.05–0.75) were found to be independent predictors of CDAD. Conclusions: The use of platinum-based chemotherapies, as well as early-stage disease, appears to be significant risk factors for the development of CDAD in gynecologic oncology patients. Attention to these risk factors is warranted to prevent the dangerous sequelae of infection with this organism.
DP
single institution from 2010 to 2015. The 2-tailed test with α = 0.05 was used for statistical significance. Results: A total of 138 patients were evaluated and 77 met study criteria: 57 (74%) with benign and 20 (26%) with malignant disease. Mean age was 13.5 years (0–21 years). The most common presentation was pain, seen in 58 (75%) of 77 cases. Mean size of the adnexal mass was 9.8 cm in the benign group and 15.5 cm in the malignant group (P = .005, 95% CI 1.81–9.58). Tumor size greater than 10 cm was found in 75% of malignancies, and all tumors 5 cm or less were benign (14%). Tumor markers were not used in 29% of the cohort; however, in cancer cases with tumor markers, 70% were elevated. A Gyn/Onc was consulted in 10 cases (13%), with 6 consults (60%) requested by pediatric gynecologists; however, only 2 (25%) of 8 were preoperative consults in malignant cases. Laparoscopy was completed in 35 (45%) of 77 patients, with most cases being benign (30/57 vs 5/20). Most common benign tumors were mature teratomas (40 [70%] of 57). In the malignant category, 11 cases (55%) were stage I; borderline ovarian tumors (7/20) were the most common, followed by immature teratomas (4/20) and mixed germ cell tumors (4/20). Conclusions: Young women with malignancies more often present with pain and large mass size (N5 cm) compared with women with benign disease. Gyn/Oncs are inconsistently involved in the management of young women and minimally invasive procedures are less commonly used. In addition, tumor markers such as αfetoprotein, lactate dehydrogenase, and human chorionic gonadotropin in this younger population should be more consistently used to better delineate preoperative involvement of the Gyn/Onc.
RO
140
doi:10.1016/j.ygyno.2016.04.366
EC
TE
335 – Poster Dissection of supraclavicular area metastatic nodes in patients with ovarian cancer in an interdisciplinary team approach S.Y. Park. National Cancer Center, Goyang-si, South Korea
UN
CO
RR
Objectives: To describe the development of and experience in dissection of metastatic nodes in the supraclavicular (SC) area in patients with ovarian cancer using an interdisciplinary team approach. Methods: From March 2012 to February 2014, 12 women underwent extended cytoreductive surgery including supraclavicular lymph node dissection (SCLND) by head and neck surgeons. The surgical extent of SCLND included compartmental level III and IV area and sometimes extended to level V area according to the clinical circumstances. Results: Optimal cytoreduction was achieved in all patients. Median operative time was 495 minutes (range, 175–635 minutes). All preoperatively identified positive lymph nodes in the SC area were completely resected with the cooperation of head and neck surgeons. In 12 patients, 9 resections occurred on the left side, 2 on the right side, and 1 on both sides. Median number of retrieved and positive lymph nodes in the SC area was 12 (range, 6–21) and 3 (range, 0– 21), respectively. There was no major complication requiring prolonged hospitalization. Chlye leakage developed in 1 patient, which was resolved by conservative management including a fatfree diet and compressive dressing. One patient experienced recurrence in surgical neck fields during follow-up (median, 14 months; range, 1–35 months). Conclusions: In patients with ovarian cancer, SCLND performed in an interdisciplinary team approach is feasible with acceptable morbidities. Long-term follow-up is needed to know the impact on survival. doi:10.1016/j.ygyno.2016.04.367
doi:10.1016/j.ygyno.2016.04.368
337 – Poster Patterns of care and predictors of survival in patients with immature teratoma S. Jorgea, N.L. Jonesb, L. Chena, J.Y. Houa, A.I. Tergasc, W.M. Burkea, J.D. Wrighta. aColumbia University College of Physicians and Surgeons, New York, NY, USA, bNYPH, Columbia University Medical Center and Weill Cornell Medical College, New York, NY, USA, cNYP/Columbia University Medical Center, New York, NY, USA Objectives: Immature ovarian teratomas are rare, comprising 5% of all ovarian cancers. Most published reports come from small, singleinstitution experiences, which limit their generalizability. We performed a population-based analysis to determine the patterns of care and outcomes of women with immature teratoma. Methods: The National Cancer Data Base (NCDB) was used to identify women diagnosed with immature teratoma from 1998 to 2012. We explored demographic and clinical characteristics, treatment trends, predictors of survival, and prognosis. Results: A total of 1,045 patients with immature teratoma were identified. Most (77.1%) were diagnosed between ages 20 and 40 years,
336 – Poster Risk factors for Clostridium difficile infection in patients undergoing treatment for gynecologic cancer E.A. Blakea, J. Sheederb, A.R. Carrubbaa, T. Oklanda, M. Hopkinsc, D.W. Doob, S.R. Guntupallib. aUniversity of Colorado, Denver, Denver, CO, USA, bUniversity of Colorado Denver, Aurora, CO, USA, cUniversity of Colorado School of Medicine, Aurora, CO, USA
OF
Objectives: Clostridium difficile–associated diarrhea (CDAD) is a common and potentially dangerous complication of treatment for gynecologic cancers and is an important metric for quality of hospital care. We sought to evaluate risk factors associated with CDAD specific to gynecologic oncology patients. Methods: In this retrospective review, all inpatient admissions to the gynecologic oncology unit of a tertiary referral center over a 4-year period were abstracted. Demographic, surgical, and medical comorbidities as well as medication use was obtained. Both surgical and medical admissions were included. Diagnosis of CDAD was only made when a positive result was confirmed with polymerase chain reaction (PCR). Standard statistical tests were used. Results: A total of 728 women were included in the analysis. Cancer diagnoses included cervical (11.0%), uterine/endometrial (32.1%), ovarian/fallopian tube/primary peritoneal (53.3%), and vulvar/vaginal (3.5%). Fifteen patients had positive PCR-proven CDAD (2.01%). In bivariate analysis, radiation treatment, surgical admission, nasogastric tube use, corticosteroid/total parenteral nutrition use, H2 blockers/proton-pump inhibitors, age, and primary disease location were not associated with CDAD. Cephalosporin use was associated with decreased risk of CDAD (55% vs 20% in those receiving cephalosporin; OR 0.21, 95% CI 0.06–0.74). Notably, platinum-based chemotherapy use (19% vs 47% in those who received a platinum agent; OR 3.61, 95% CI 1.29–10.13) and early stage (29% vs 60% with stage I-II disease; OR 3.59, 95% CI 1.26–10.21) were associated with increased risk of CDAD. In logistic regression analysis, platinum agents (aOR 5.7, 95% CI 1.91–17.10), early-stage disease (aOR 5.7, 95% CI 1.22–11.05), and cephalosporins (aOR 0.20, 95% CI 0.05–0.75) were found to be independent predictors of CDAD. Conclusions: The use of platinum-based chemotherapies, as well as early-stage disease, appears to be significant risk factors for the development of CDAD in gynecologic oncology patients. Attention to these risk factors is warranted to prevent the dangerous sequelae of infection with this organism.
DP
single institution from 2010 to 2015. The 2-tailed test with α = 0.05 was used for statistical significance. Results: A total of 138 patients were evaluated and 77 met study criteria: 57 (74%) with benign and 20 (26%) with malignant disease. Mean age was 13.5 years (0–21 years). The most common presentation was pain, seen in 58 (75%) of 77 cases. Mean size of the adnexal mass was 9.8 cm in the benign group and 15.5 cm in the malignant group (P = .005, 95% CI 1.81–9.58). Tumor size greater than 10 cm was found in 75% of malignancies, and all tumors 5 cm or less were benign (14%). Tumor markers were not used in 29% of the cohort; however, in cancer cases with tumor markers, 70% were elevated. A Gyn/Onc was consulted in 10 cases (13%), with 6 consults (60%) requested by pediatric gynecologists; however, only 2 (25%) of 8 were preoperative consults in malignant cases. Laparoscopy was completed in 35 (45%) of 77 patients, with most cases being benign (30/57 vs 5/20). Most common benign tumors were mature teratomas (40 [70%] of 57). In the malignant category, 11 cases (55%) were stage I; borderline ovarian tumors (7/20) were the most common, followed by immature teratomas (4/20) and mixed germ cell tumors (4/20). Conclusions: Young women with malignancies more often present with pain and large mass size (N5 cm) compared with women with benign disease. Gyn/Oncs are inconsistently involved in the management of young women and minimally invasive procedures are less commonly used. In addition, tumor markers such as αfetoprotein, lactate dehydrogenase, and human chorionic gonadotropin in this younger population should be more consistently used to better delineate preoperative involvement of the Gyn/Onc.
RO
140
doi:10.1016/j.ygyno.2016.04.366
EC
TE
335 – Poster Dissection of supraclavicular area metastatic nodes in patients with ovarian cancer in an interdisciplinary team approach S.Y. Park. National Cancer Center, Goyang-si, South Korea
UN
CO
RR
Objectives: To describe the development of and experience in dissection of metastatic nodes in the supraclavicular (SC) area in patients with ovarian cancer using an interdisciplinary team approach. Methods: From March 2012 to February 2014, 12 women underwent extended cytoreductive surgery including supraclavicular lymph node dissection (SCLND) by head and neck surgeons. The surgical extent of SCLND included compartmental level III and IV area and sometimes extended to level V area according to the clinical circumstances. Results: Optimal cytoreduction was achieved in all patients. Median operative time was 495 minutes (range, 175–635 minutes). All preoperatively identified positive lymph nodes in the SC area were completely resected with the cooperation of head and neck surgeons. In 12 patients, 9 resections occurred on the left side, 2 on the right side, and 1 on both sides. Median number of retrieved and positive lymph nodes in the SC area was 12 (range, 6–21) and 3 (range, 0– 21), respectively. There was no major complication requiring prolonged hospitalization. Chlye leakage developed in 1 patient, which was resolved by conservative management including a fatfree diet and compressive dressing. One patient experienced recurrence in surgical neck fields during follow-up (median, 14 months; range, 1–35 months). Conclusions: In patients with ovarian cancer, SCLND performed in an interdisciplinary team approach is feasible with acceptable morbidities. Long-term follow-up is needed to know the impact on survival. doi:10.1016/j.ygyno.2016.04.367
doi:10.1016/j.ygyno.2016.04.368
337 – Poster Patterns of care and predictors of survival in patients with immature teratoma S. Jorgea, N.L. Jonesb, L. Chena, J.Y. Houa, A.I. Tergasc, W.M. Burkea, J.D. Wrighta. aColumbia University College of Physicians and Surgeons, New York, NY, USA, bNYPH, Columbia University Medical Center and Weill Cornell Medical College, New York, NY, USA, cNYP/Columbia University Medical Center, New York, NY, USA Objectives: Immature ovarian teratomas are rare, comprising 5% of all ovarian cancers. Most published reports come from small, singleinstitution experiences, which limit their generalizability. We performed a population-based analysis to determine the patterns of care and outcomes of women with immature teratoma. Methods: The National Cancer Data Base (NCDB) was used to identify women diagnosed with immature teratoma from 1998 to 2012. We explored demographic and clinical characteristics, treatment trends, predictors of survival, and prognosis. Results: A total of 1,045 patients with immature teratoma were identified. Most (77.1%) were diagnosed between ages 20 and 40 years,