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Published on: September 12, 2019
The importance of surgery at an oncologic institution as a prognostic factor in patients with endometrial carcinoma
Salim Abraham Barquet-Muñoz1, Caleb García Arango1, Kristal Regina Pech Oxte1
1Departamento de Ginecología, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, CDMX, Ciudad de México, 14080, Mexico.
Objective:
To evaluate the impact of initial surgery location on prognosis among patients with endometrial carcinoma.
Methods:
We conducted a retrospective cohort study of patients treated at the National Cancer Institute of Mexico between 2006 and 2023. Two groups were compared: patients who underwent primary surgery at the cancer center (Group 1) and those initially treated surgically at noncancer centers and later referred for management (Group 2). Survival outcomes were analyzed using Kaplan-Meier estimates and compared by log-rank test. Cox proportional hazards models were used for univariate and multivariate analyses. Temporal trends were evaluated using joinpoint regression. Statistical significance was set at p < 0.05.
Results:
Among 1887 patients reviewed, 1204 (63.8%) were initially operated on at the cancer center and 683 (36.2%) elsewhere. Patients in Group 2 had more incomplete pathology reports, more advanced stages, and more frequent use of adjuvant therapy. The mean follow-up was 50.7 months. Five-year overall survival (88.5% vs 77.2%, p < 0.001) and disease-free survival (86.0% vs 71.4%, p < 0.001) were significantly lower in Group 2. Initial surgery performed outside the cancer center was independently associated with poorer overall survival (HR 15.75; 95% CI, 9.22-26.9; p < 0.001) and disease-free survival (HR 24.01; 95% CI, 14.62-39.43; p < 0.001). The proportion of patients initially treated elsewhere increased markedly from 2021 to 2023 (APC 67.97).
Conclusions:
Patients with endometrial carcinoma undergoing primary surgery at nononcologic institutions experience significantly poorer survival, likely related to incomplete surgical staging and limited pathological data to guide adjuvant therapy.
