3 results on '"Bregar AJ"'
Search Results
2. Disparities in receipt of care for high-grade endometrial cancer: A National Cancer Data Base analysis.
- Author
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Bregar AJ, Alejandro Rauh-Hain J, Spencer R, Clemmer JT, Schorge JO, Rice LW, and Del Carmen MG
- Subjects
- Adenocarcinoma, Clear Cell mortality, Adenocarcinoma, Clear Cell pathology, Adenocarcinoma, Papillary mortality, Adenocarcinoma, Papillary pathology, Adenocarcinoma, Papillary therapy, Black or African American statistics & numerical data, Aged, Carcinoma, Endometrioid mortality, Carcinoma, Endometrioid pathology, Carcinosarcoma mortality, Carcinosarcoma pathology, Cause of Death, Comorbidity, Databases, Factual, Education, Endometrial Neoplasms mortality, Endometrial Neoplasms pathology, Female, Healthcare Disparities statistics & numerical data, Hispanic or Latino statistics & numerical data, Humans, Insurance Coverage, Kaplan-Meier Estimate, Middle Aged, Neoplasm Grading, Neoplasm Staging, Neoplasms, Cystic, Mucinous, and Serous mortality, Neoplasms, Cystic, Mucinous, and Serous pathology, Neoplasms, Cystic, Mucinous, and Serous therapy, Proportional Hazards Models, Retrospective Studies, Social Class, Survival Rate, United States, White People statistics & numerical data, Adenocarcinoma, Clear Cell therapy, Carcinoma, Endometrioid therapy, Carcinosarcoma therapy, Chemotherapy, Adjuvant statistics & numerical data, Endometrial Neoplasms therapy, Ethnicity statistics & numerical data, Healthcare Disparities ethnology, Hysterectomy statistics & numerical data
- Abstract
Purpose: To examine patterns of care and survival for Hispanic women compared to white and African American women with high-grade endometrial cancer., Methods: We utilized the National Cancer Data Base (NCDB) to identify women diagnosed with uterine grade 3 endometrioid adenocarcinoma, carcinosarcoma, clear cell carcinoma and papillary serous carcinoma between 2003 and 2011. The effect of treatment on survival was analyzed using the Kaplan-Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model., Results: 43,950 women were eligible. African American and Hispanic women had higher rates of stage III and IV disease compared to white women (36.5% vs. 36% vs. 33.5%, p<0.001). African American women were less likely to undergo surgical treatment for their cancer (85.2% vs. 89.8% vs. 87.5%, p<0.001) and were more likely to receive chemotherapy (36.8% vs. 32.4% vs. 32%, p<0.001) compared to white and Hispanic women. Over the entire study period, after adjusting for age, time period of diagnosis, region of the country, urban or rural setting, treating facility type, socioeconomic status, education, insurance, comorbidity index, pathologic stage, histology, lymphadenectomy and adjuvant treatment, African American women had lower overall survival compared to white women (Hazard Ratio 1.21, 95% CI 1.16-1.26). Conversely, Hispanic women had improved overall survival compared to white women after controlling for the aforementioned factors (HR 0.87, 95% CI 0.80-0.93)., Conclusions: Among women with high-grade endometrial cancer, African American women have lower all-cause survival while Hispanic women have higher all-cause survival compared to white women after controlling for treatment, sociodemographic, comorbidity and histopathologic variables., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
3. Laparoscopic staging for apparent stage I epithelial ovarian cancer.
- Author
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Melamed A, Keating NL, Clemmer JT, Bregar AJ, Wright JD, Boruta DM, Schorge JO, Del Carmen MG, and Rauh-Hain JA
- Subjects
- Adenocarcinoma pathology, Adenocarcinoma surgery, Adenocarcinoma, Clear Cell pathology, Adult, Aged, Aged, 80 and over, Cancer Care Facilities statistics & numerical data, Carcinoma, Endometrioid pathology, Carcinoma, Ovarian Epithelial, Chemotherapy, Adjuvant, Conversion to Open Surgery statistics & numerical data, Databases, Factual, Female, Humans, Kaplan-Meier Estimate, Lymph Node Excision, Middle Aged, Neoplasm Staging, Neoplasms, Cystic, Mucinous, and Serous pathology, Neoplasms, Glandular and Epithelial pathology, Ovarian Neoplasms pathology, Propensity Score, Proportional Hazards Models, Residence Characteristics statistics & numerical data, Survival Rate, Tumor Burden, White People, Adenocarcinoma, Clear Cell surgery, Carcinoma, Endometrioid surgery, Insurance, Health statistics & numerical data, Laparoscopy statistics & numerical data, Lymph Nodes pathology, Neoplasms, Cystic, Mucinous, and Serous surgery, Neoplasms, Glandular and Epithelial surgery, Ovarian Neoplasms surgery
- Abstract
Background: Whereas advances in minimally invasive surgery have made laparoscopic staging technically feasible in stage I epithelial ovarian cancer, the practice remains controversial because of an absence of randomized trials and lack of high-quality observational studies demonstrating equivalent outcomes., Objective: This study seeks to evaluate the association of laparoscopic staging with survival among women with clinical stage I epithelial ovarian cancer., Study Design: We used the National Cancer Data Base to identify all women who underwent surgical staging for clinical stage I epithelial ovarian cancer diagnosed from 2010 through 2012. The exposure of interest was planned surgical approach (laparoscopy vs laparotomy), and the primary outcome was overall survival. The primary analysis was based on an intention to treat: all women whose procedures were initiated laparoscopically were categorized as having had a planned laparoscopic procedure, regardless of subsequent conversion to laparotomy. We used propensity methods to match patients who underwent planned laparoscopic staging with similar patients who underwent planned laparotomy based on observed characteristics. We compared survival among the matched cohorts using the Kaplan-Meier method and Cox regression. We compared the extent of lymphadenectomy using the Wilcoxon rank-sum test., Results: Among 4798 eligible patients, 1112 (23.2%) underwent procedures that were initiated laparoscopically, of which 190 (17%) were converted to laparotomy. Women who underwent planned laparoscopy were more frequently white, privately insured, from wealthier ZIP codes, received care in community cancer centers, and had smaller tumors that were more frequently of serous and less often of mucinous histology than those who underwent staging via planned laparotomy. After propensity score matching, time to death did not differ between patients undergoing planned laparoscopic vs open staging (hazard ratio, 0.77, 95% confidence interval, 0.54-1.09; P = .13). Planned laparoscopic staging was associated with a slightly higher median lymph node count (14 vs 12, P = .005). Planned laparoscopic staging was not associated with time to death after adjustment for receipt of adjuvant chemotherapy, histological type and grade, and pathological stage (hazard ratio, 0.82, 95% confidence interval, 0.57-1.16)., Conclusion: Surgical staging via planned laparoscopy vs laparotomy was not associated with worse survival in women with apparent stage I epithelial ovarian cancer., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
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