Surgery within 2 weeks or after more than 8 weeks of endometrial cancer diagnosis may worsen survival because of perioperative death and outcomes at low-surgical-volume centers, warned authors of a study published in the American Journal of Obstetrics and Gynecology.1
“Delay in surgical treatment was a risk factor for mortality in low-risk cancers only and was likely associated with poor access to specialty care,” reported lead author David Shalowitz, MD, of the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, and colleagues.
The study authors suggested that treatment for endometrial cancers should begin within 8 weeks of diagnosis but that “referral to an experienced surgeon … should be prioritized over expedited surgery.”
More than 60,000 women are expected to be newly diagnosed with endometrial cancer in 2017, the authors noted.
The study team reviewed data for more than 200,000 women with endometrial cancer in the United States, 140,078 had low-risk tumors.
Patients who had surgery in the first 2 weeks after diagnosis had a 14% higher 5-year mortality risk overall when compared to patients whose surgeries occurred in the third to fourth week after diagnosis. Among the 68360 patients with high-risk cancers, the 5-year mortality rate was 20%.
Patients undergoing surgery in the first two weeks died more frequently within a month of surgery than the other patients (0.7% vs. 0.4%; P < .001). That might suggest that differences in cancer care and not tumor biology likely explain the findings, they suggested.
“We suspect that physicians diagnosing endometrial cancer may believe, not unreasonably, that the best thing they can do for those patients is to operate as soon as possible, because if they wait too long the cancer could progress, resulting in a worse outcome,” said Dr Shalowitz.2 “But, the results of our study suggest that presurgical care and referring patients to a gynecologic oncologist may be more important.”
1. Shalowitz DI, Epstein AJ, Buckingham L, Ko EM, Giuntoli RL. Survival implications of time to surgical treatment of endometrial cancers. Am J Obstet Gynecol. 2017. DOI: 10.1016/j.ajog.2016.11.1050. [Epub ahead of print.]
2. University of Pennsylvania School of Medicine. Press release: Early surgery increases risk of death for some uterine cancer patients, Penn study finds. https://www.pennmedicine.org/news/news-releases/2016/december/early-surgery-increases-risk-of-death-for-some-uterine-cancer-patients. December 16, 2016.