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Undifferentiated endometrial sarcoma: Does adjuvant treatment impact outcomes of stage I disease?
Abstracts / Gynecologic Oncology 141 (2016) 2–208
DP
Objectives: Undifferentiated endometrial sarcoma (UES) is an aggressive rare malignancy with no treatment consensus. Treatment of stage I disease is surgery with either observation or adjuvant chemo- and/or radiation therapy (RT). Our goal was to assess the outcomes of various treatment modalities, and to identify prognostic factors associated with survival. Methods: Patients with undifferentiated endometrial sarcoma reported to the National Cancer Data Base from 1998 to 2012 who underwent at least a total hysterectomy were selected. To exclude for potentially palliative interventions, we included only patients with stage I disease for this analysis. Overall survival was estimated using the Kaplan-Meier method, univariate comparisons were made with log-rank tests, and multivariable analysis was performed using Cox proportional hazards modeling. All tests were 2-tailed with threshold significance level set at P b .05. Results: A total of 2,202 undifferentiated endometrial sarcoma cancer patients were identified, and 552 patients met inclusion criteria. Increasing tumor size was significantly associated with a decrease in survival (5-year overall survival [OS] 61%, 54%, 37% for sizes b5 cm, 5–10 cm, N10 cm, respectively; P b .001). The 5-year OS for stage IA (61%) and IB (53%) was also significant (P = .01). Comparison of adjuvant therapy for stage IA showed no significant difference in treatment outcomes (P = .554). For stage IB, there was an increasing nonsignificant trend in survival when comparing no treatment, RT only, chemotherapy only, and chemotherapy + RT, respectively (5-year OS 38%, 50%, 53%, 62%, respectively; P = .125). No other factors were found to be associated with survival on univariate analyses including age, race, insurance, income, education, residential setting, year of diagnosis, facility type/ location/distance, or Lymphovascular space invasion. On multivariable analysis, only tumor size (HR 2.5, 95% CI 1.641–3.818, P = .001) and stage (HR 0.549, 95% CI 0.39–0.772, P = .001) significantly predicted survival. Conclusions: Increased tumor size in UES confined to the uterus is a poor prognostic factor. There was no difference in survival in stage IA patients receiving adjuvant therapy versus observation. When present, prognosis in stage IB disease is worse. However, the type of adjuvant therapy or combination is unclear. Optimal treatment of this disease remains elusive.
Methods: Two distinct interventions to improve HPV vaccination were introduced to a prospective cohort of postpartum patients at 2 affiliated county hospitals in November 2014: a nursing protocol at hospital A and an EMR postpartum order set at hospital B. All eligible patients ages 26 years and less were identified for the subsequent 6 months (n = 237). Descriptive statistical methods were used to assess baseline characteristics of the 2 groups. A multiple logistic regression model was used to compare postintervention vaccination rates. Results: The 2 groups had similar baseline characteristics with regard to age but differed significantly in ethnicity, race, language, insurance status, and sites of prenatal care (hospital clinic based versus outside clinic based). At Hospital B, 66% of eligible patients accepted the HPV vaccine when offered whereas at Hospital A, only 32% of eligible patients accepted the vaccine when offered. Based on univariate association tests, ethnicity, language, and site of prenatal care were identified as covariates believed to affect the association between outcome and intervention methods. After adjusting for these variables, patients at Hospital B were 5 times more likely to get the vaccination than those at Hospital A (OR 5.865, CI 3.358–10.245, P b .0001). Conclusions: EMR-based interventions are a highly successful method of increasing HPV vaccination in the hospital setting, more so than nurse-driven protocols. Neither intervention required additional financial resources for implementation. Ongoing research is needed to identify ways to reduce patient refusal rates and missed opportunities to increase HPV vaccination rates in the inpatient clinical setting.
OF
289 – Poster Undifferentiated endometrial sarcoma: Does adjuvant treatment impact outcomes of stage I disease? B.C. Orra, J.F. Lina, R.P. Edwardsa, J.L. Kelley IIIa, A.B. Olawaiyea, J.T. Comercib, M. Huanga, M. Courtney-Brooksa, S.E. Taylora, P. Sukumvanicha. aMagee-Womens Hospital of UPMC, Pittsburgh, PA, USA, bUniversity of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
RO
120
doi:10.1016/j.ygyno.2016.04.322
CO
RR
EC
TE
291 – Poster Use of near-infrared angiography during rectosigmoid resection and reanastomosis in women with gynecologic malignancies M.B. Schiavone, V. Sioulas, M. Bielen, Y. Sonoda, G.J. Gardner, K.C. Long, M.M. Leitao, N.R. Abu-Rustum, D.S. Chi, O. Zivanovic. Memorial Sloan Kettering Cancer Center, New York, NY, USA
doi:10.1016/j.ygyno.2016.04.321
UN
290 – Poster Increasing HPV vaccination in the postpartum population using an EMR-based versus nursing protocol intervention S.K. Parka, C.H. Holschneiderb, E. Saleebyc, J. Chend, R. Singhale. a University of California, Riverside, Riverside, CA, USA, bDavid Geffen School of Medicine at UCLA, Los Angeles, CA, USA, cHarbor-UCLA Medical Center, Torrance, CA, USA, dKeck School of Medicine of USC, Los Angeles, CA, USA, eLos Angeles County Department of Public Health, El Monte, CA, USA Objectives: Vaccination rate against the human papillomavirus (HPV) is low in the United States. With the widespread implementation of electronic medical records (EMR), there is an opportunity to study the impact of EMR-driven interventions compared with other provider-based interventions to increase vaccination rates.
Objectives: To investigate the usefulness of near-infrared angiography (NIRA) for the assessment of anastomotic perfusion at the time of rectosigmoid resection and reanastomosis in women undergoing surgery for gynecologic cancer. Methods: We retrospectively identified all patients who underwent rectosigmoid resection for a gynecologic malignancy between 2013 and 2015. NIRA was assessed using a fluorescence-based endoscopic imaging system. Various clinicopathologic data were abstracted and analyzed. Appropriate statistical tests were used. Results: Of the 175 patients identified, NIRA was used in 32 (18%). No statistically significant differences were noted in age, body mass index (BMI), hypertension, diabetes, preoperative albumin levels, steroid use, or history of preoperative radiation or chemotherapy between the NIRA and non-NIRA patient groups. The primary indication for surgery was ovarian carcinoma in both groups (84% for both, P = .9). Seventeen (53%) of 32 NIRA patients underwent primary debulking surgery compared with 78 (54%) of 143 non-NIRA patients (P = .9). All cases of rectosigmoid resection underwent stapled primary anastomosis. “Highrisk” anastomoses, characterized by an anastomotic height of less than 10 cm from the dentate line, were found in 7 (22%) of 32 NIRA patients versus 39 (27%) of 143 non-NIRA patients (P = .1). Diverting ileostomy was performed in 2 (6%) of 32 compared with 34 (24%) of 143 patients, respectively (P = .029). Postoperative abscess was noted in 2 (6%) of 32 compared with 25 (17%) of 143 patients, respectively (P = .2). Incidence of rectal anastomotic leak was found in 1 (3%) of 32 compared with 8 (6%) of 143 patients, respectively (P = 1.0). Conclusions: In the setting of rectosigmoid resection, NIRA appears to be a safe adjunct to primary reanastomosis and can help guide
DP
Objectives: Undifferentiated endometrial sarcoma (UES) is an aggressive rare malignancy with no treatment consensus. Treatment of stage I disease is surgery with either observation or adjuvant chemo- and/or radiation therapy (RT). Our goal was to assess the outcomes of various treatment modalities, and to identify prognostic factors associated with survival. Methods: Patients with undifferentiated endometrial sarcoma reported to the National Cancer Data Base from 1998 to 2012 who underwent at least a total hysterectomy were selected. To exclude for potentially palliative interventions, we included only patients with stage I disease for this analysis. Overall survival was estimated using the Kaplan-Meier method, univariate comparisons were made with log-rank tests, and multivariable analysis was performed using Cox proportional hazards modeling. All tests were 2-tailed with threshold significance level set at P b .05. Results: A total of 2,202 undifferentiated endometrial sarcoma cancer patients were identified, and 552 patients met inclusion criteria. Increasing tumor size was significantly associated with a decrease in survival (5-year overall survival [OS] 61%, 54%, 37% for sizes b5 cm, 5–10 cm, N10 cm, respectively; P b .001). The 5-year OS for stage IA (61%) and IB (53%) was also significant (P = .01). Comparison of adjuvant therapy for stage IA showed no significant difference in treatment outcomes (P = .554). For stage IB, there was an increasing nonsignificant trend in survival when comparing no treatment, RT only, chemotherapy only, and chemotherapy + RT, respectively (5-year OS 38%, 50%, 53%, 62%, respectively; P = .125). No other factors were found to be associated with survival on univariate analyses including age, race, insurance, income, education, residential setting, year of diagnosis, facility type/ location/distance, or Lymphovascular space invasion. On multivariable analysis, only tumor size (HR 2.5, 95% CI 1.641–3.818, P = .001) and stage (HR 0.549, 95% CI 0.39–0.772, P = .001) significantly predicted survival. Conclusions: Increased tumor size in UES confined to the uterus is a poor prognostic factor. There was no difference in survival in stage IA patients receiving adjuvant therapy versus observation. When present, prognosis in stage IB disease is worse. However, the type of adjuvant therapy or combination is unclear. Optimal treatment of this disease remains elusive.
Methods: Two distinct interventions to improve HPV vaccination were introduced to a prospective cohort of postpartum patients at 2 affiliated county hospitals in November 2014: a nursing protocol at hospital A and an EMR postpartum order set at hospital B. All eligible patients ages 26 years and less were identified for the subsequent 6 months (n = 237). Descriptive statistical methods were used to assess baseline characteristics of the 2 groups. A multiple logistic regression model was used to compare postintervention vaccination rates. Results: The 2 groups had similar baseline characteristics with regard to age but differed significantly in ethnicity, race, language, insurance status, and sites of prenatal care (hospital clinic based versus outside clinic based). At Hospital B, 66% of eligible patients accepted the HPV vaccine when offered whereas at Hospital A, only 32% of eligible patients accepted the vaccine when offered. Based on univariate association tests, ethnicity, language, and site of prenatal care were identified as covariates believed to affect the association between outcome and intervention methods. After adjusting for these variables, patients at Hospital B were 5 times more likely to get the vaccination than those at Hospital A (OR 5.865, CI 3.358–10.245, P b .0001). Conclusions: EMR-based interventions are a highly successful method of increasing HPV vaccination in the hospital setting, more so than nurse-driven protocols. Neither intervention required additional financial resources for implementation. Ongoing research is needed to identify ways to reduce patient refusal rates and missed opportunities to increase HPV vaccination rates in the inpatient clinical setting.
OF
289 – Poster Undifferentiated endometrial sarcoma: Does adjuvant treatment impact outcomes of stage I disease? B.C. Orra, J.F. Lina, R.P. Edwardsa, J.L. Kelley IIIa, A.B. Olawaiyea, J.T. Comercib, M. Huanga, M. Courtney-Brooksa, S.E. Taylora, P. Sukumvanicha. aMagee-Womens Hospital of UPMC, Pittsburgh, PA, USA, bUniversity of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
RO
120
doi:10.1016/j.ygyno.2016.04.322
CO
RR
EC
TE
291 – Poster Use of near-infrared angiography during rectosigmoid resection and reanastomosis in women with gynecologic malignancies M.B. Schiavone, V. Sioulas, M. Bielen, Y. Sonoda, G.J. Gardner, K.C. Long, M.M. Leitao, N.R. Abu-Rustum, D.S. Chi, O. Zivanovic. Memorial Sloan Kettering Cancer Center, New York, NY, USA
doi:10.1016/j.ygyno.2016.04.321
UN
290 – Poster Increasing HPV vaccination in the postpartum population using an EMR-based versus nursing protocol intervention S.K. Parka, C.H. Holschneiderb, E. Saleebyc, J. Chend, R. Singhale. a University of California, Riverside, Riverside, CA, USA, bDavid Geffen School of Medicine at UCLA, Los Angeles, CA, USA, cHarbor-UCLA Medical Center, Torrance, CA, USA, dKeck School of Medicine of USC, Los Angeles, CA, USA, eLos Angeles County Department of Public Health, El Monte, CA, USA Objectives: Vaccination rate against the human papillomavirus (HPV) is low in the United States. With the widespread implementation of electronic medical records (EMR), there is an opportunity to study the impact of EMR-driven interventions compared with other provider-based interventions to increase vaccination rates.
Objectives: To investigate the usefulness of near-infrared angiography (NIRA) for the assessment of anastomotic perfusion at the time of rectosigmoid resection and reanastomosis in women undergoing surgery for gynecologic cancer. Methods: We retrospectively identified all patients who underwent rectosigmoid resection for a gynecologic malignancy between 2013 and 2015. NIRA was assessed using a fluorescence-based endoscopic imaging system. Various clinicopathologic data were abstracted and analyzed. Appropriate statistical tests were used. Results: Of the 175 patients identified, NIRA was used in 32 (18%). No statistically significant differences were noted in age, body mass index (BMI), hypertension, diabetes, preoperative albumin levels, steroid use, or history of preoperative radiation or chemotherapy between the NIRA and non-NIRA patient groups. The primary indication for surgery was ovarian carcinoma in both groups (84% for both, P = .9). Seventeen (53%) of 32 NIRA patients underwent primary debulking surgery compared with 78 (54%) of 143 non-NIRA patients (P = .9). All cases of rectosigmoid resection underwent stapled primary anastomosis. “Highrisk” anastomoses, characterized by an anastomotic height of less than 10 cm from the dentate line, were found in 7 (22%) of 32 NIRA patients versus 39 (27%) of 143 non-NIRA patients (P = .1). Diverting ileostomy was performed in 2 (6%) of 32 compared with 34 (24%) of 143 patients, respectively (P = .029). Postoperative abscess was noted in 2 (6%) of 32 compared with 25 (17%) of 143 patients, respectively (P = .2). Incidence of rectal anastomotic leak was found in 1 (3%) of 32 compared with 8 (6%) of 143 patients, respectively (P = 1.0). Conclusions: In the setting of rectosigmoid resection, NIRA appears to be a safe adjunct to primary reanastomosis and can help guide