1Department of Nursing, Chosun University College of Medicine, Gwangju, Korea
2Department of Public Health, Korea University, Seoul, Korea
3Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
4Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
5Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA, USA
6Center for Uterine Cancer and Center for Clinical Trials, Hospital, National Cancer Center, Goyang, Korea
7Cancer Healthcare Research Branch, Precision Medicine Branch, and Common Cancer Branch, Research Institute, National Cancer Center, Goyang, Korea
8Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
9Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
Copyright © 2019 by the Korean Cancer Association
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Characteristic | Total |
Unadjusted |
Inverse probability of treatment weightinga) |
||||
---|---|---|---|---|---|---|---|
Abdominal RH | Laparoscopic RH | p-valueb) | Abdominal RH | Laparoscopic RH | p-valuec) | ||
Total patients | 6,335 (100) | 3,235 (100) | 3,100 (100) | 3,171 (100) | 3,166 (100) | ||
Age at operation (yr) | |||||||
≤ 39 | 1,265 (20.0) | 587 (18.1) | 678 (21.9) | < 0.001 | 617 (19.5) | 634 (20.0) | 0.785 |
40-49 | 2,066 (32.6) | 1,044 (32.3) | 1,022 (33.0) | 1,045 (33.0) | 1,020 (32.2) | ||
50-59 | 1,732 (27.3) | 898 (27.8) | 834 (26.9) | 869 (27.4) | 874 (27.6) | ||
≥ 60 | 1,272 (20.1) | 706 (21.8) | 566 (18.3) | 640 (20.2) | 638 (20.2) | ||
Year of diagnosis | |||||||
2011 | 1,617 (25.5) | 872 (27.0) | 745 (24.0) | 0.016 | 813 (25.6) | 807 (25.5) | 0.647 |
2012 | 1,572 (24.8) | 806 (24.9) | 766 (24.7) | 777 (24.5) | 800 (25.3) | ||
2013 | 1,648 (26.0) | 835 (25.8) | 813 (26.2) | 836 (26.4) | 809 (25.6) | ||
2014 | 1,498 (23.6) | 722 (22.3) | 776 (25.0) | 745 (23.5) | 750 (23.7) | ||
Insurance status | |||||||
Medicare | 6,084 (96.0) | 3,071 (94.9) | 3,013 (97.2) | < 0.001 | 3,044 (96.0) | 3,041 (96.1) | 0.910 |
Medicaid | 251 (4.0) | 164 (5.1) | 87 (2.8) | 127 (4.0) | 125 (3.9) | ||
Comorbidities (CCI score) | |||||||
2 | 1,874 (29.6) | 922 (28.5) | 952 (30.7) | < 0.001 | 941 (29.7) | 934 (29.5) | 0.988 |
3 | 1,502 (23.7) | 703 (21.7) | 799 (25.8) | 749 (23.6) | 744 (23.5) | ||
4 | 775 (12.2) | 364 (11.3) | 411 (13.3) | 390 (12.3) | 388 (12.3) | ||
≥ 5 | 2,184 (34.5) | 1,246 (38.5) | 938 (30.3) | 1,091 (34.4) | 1,100 (34.7) | ||
Para-aortic lymphadenectomy | |||||||
Yes | 2,410 (38.0) | 1,354 (41.9) | 1,056 (34.1) | < 0.001 | 1,198 (37.8) | 1,191 (37.6) | 0.827 |
No | 3,925 (62.0) | 1,881 (58.1) | 2,044 (65.9) | 1,973 (62.2) | 1,975 (62.4) | ||
Hospital location | |||||||
Metropolitan | 4,635 (73.2) | 2,365 (73.1) | 2,270 (73.2) | 0.915 | 2,304 (72.7) | 2,294 (72.5) | 0.803 |
Nonmetropolitan | 1,700 (26.8) | 870 (26.9) | 830 (26.8) | 867 (27.3) | 872 (27.5) | ||
Hospital region | |||||||
Metropolitan area | 4,216 (66.6) | 1,963 (60.7) | 2,253 (72.7) | < 0.001 | 2,114 (66.7) | 2,109 (66.6) | 0.869 |
Middle | 259 (4.1) | 136 (4.2) | 123 (4.0) | 131 (4.1) | 133 (4.2) | ||
East | 57 (0.9) | 47 (1.5) | 10 (0.3) | 28 (0.9) | 34 (1.1) | ||
South West | 379 (6.0) | 226 (7.0) | 153 (4.9) | 191 (6.0) | 193 (6.1) | ||
South East | 1,424 (22.5) | 863 (26.7) | 561 (18.1) | 707 (22.3) | 697 (22.0) | ||
Hospital volume | |||||||
Tertiary general hospital | 4,220 (66.6) | 2,164 (66.9) | 2,056 (66.3) | 0.061 | 2,080 (65.6) | 2,070 (65.4) | 0.935 |
General hospital | 2,097 (33.1) | 1,057 (32.7) | 1,040 (33.5) | 1,082 (34.1) | 1,086 (34.3) | ||
Hospital and clinic | 18 (0.3) | 14 (0.4) | 4 (0.1) | 9 (0.3) | 10 (0.3) |
Characteristic | Total | Unadjusted |
Inverse probability of treatment weighting |
||||
---|---|---|---|---|---|---|---|
Abdominal RH | Laparoscopic RH | p-value |
Abdominal RH | Laparoscopic RH | p-value |
||
Total patients | 6,335 (100) | 3,235 (100) | 3,100 (100) | 3,171 (100) | 3,166 (100) | ||
Age at operation (yr) | |||||||
≤ 39 | 1,265 (20.0) | 587 (18.1) | 678 (21.9) | < 0.001 | 617 (19.5) | 634 (20.0) | 0.785 |
40-49 | 2,066 (32.6) | 1,044 (32.3) | 1,022 (33.0) | 1,045 (33.0) | 1,020 (32.2) | ||
50-59 | 1,732 (27.3) | 898 (27.8) | 834 (26.9) | 869 (27.4) | 874 (27.6) | ||
≥ 60 | 1,272 (20.1) | 706 (21.8) | 566 (18.3) | 640 (20.2) | 638 (20.2) | ||
Year of diagnosis | |||||||
2011 | 1,617 (25.5) | 872 (27.0) | 745 (24.0) | 0.016 | 813 (25.6) | 807 (25.5) | 0.647 |
2012 | 1,572 (24.8) | 806 (24.9) | 766 (24.7) | 777 (24.5) | 800 (25.3) | ||
2013 | 1,648 (26.0) | 835 (25.8) | 813 (26.2) | 836 (26.4) | 809 (25.6) | ||
2014 | 1,498 (23.6) | 722 (22.3) | 776 (25.0) | 745 (23.5) | 750 (23.7) | ||
Insurance status | |||||||
Medicare | 6,084 (96.0) | 3,071 (94.9) | 3,013 (97.2) | < 0.001 | 3,044 (96.0) | 3,041 (96.1) | 0.910 |
Medicaid | 251 (4.0) | 164 (5.1) | 87 (2.8) | 127 (4.0) | 125 (3.9) | ||
Comorbidities (CCI score) | |||||||
2 | 1,874 (29.6) | 922 (28.5) | 952 (30.7) | < 0.001 | 941 (29.7) | 934 (29.5) | 0.988 |
3 | 1,502 (23.7) | 703 (21.7) | 799 (25.8) | 749 (23.6) | 744 (23.5) | ||
4 | 775 (12.2) | 364 (11.3) | 411 (13.3) | 390 (12.3) | 388 (12.3) | ||
≥ 5 | 2,184 (34.5) | 1,246 (38.5) | 938 (30.3) | 1,091 (34.4) | 1,100 (34.7) | ||
Para-aortic lymphadenectomy | |||||||
Yes | 2,410 (38.0) | 1,354 (41.9) | 1,056 (34.1) | < 0.001 | 1,198 (37.8) | 1,191 (37.6) | 0.827 |
No | 3,925 (62.0) | 1,881 (58.1) | 2,044 (65.9) | 1,973 (62.2) | 1,975 (62.4) | ||
Hospital location | |||||||
Metropolitan | 4,635 (73.2) | 2,365 (73.1) | 2,270 (73.2) | 0.915 | 2,304 (72.7) | 2,294 (72.5) | 0.803 |
Nonmetropolitan | 1,700 (26.8) | 870 (26.9) | 830 (26.8) | 867 (27.3) | 872 (27.5) | ||
Hospital region | |||||||
Metropolitan area | 4,216 (66.6) | 1,963 (60.7) | 2,253 (72.7) | < 0.001 | 2,114 (66.7) | 2,109 (66.6) | 0.869 |
Middle | 259 (4.1) | 136 (4.2) | 123 (4.0) | 131 (4.1) | 133 (4.2) | ||
East | 57 (0.9) | 47 (1.5) | 10 (0.3) | 28 (0.9) | 34 (1.1) | ||
South West | 379 (6.0) | 226 (7.0) | 153 (4.9) | 191 (6.0) | 193 (6.1) | ||
South East | 1,424 (22.5) | 863 (26.7) | 561 (18.1) | 707 (22.3) | 697 (22.0) | ||
Hospital volume | |||||||
Tertiary general hospital | 4,220 (66.6) | 2,164 (66.9) | 2,056 (66.3) | 0.061 | 2,080 (65.6) | 2,070 (65.4) | 0.935 |
General hospital | 2,097 (33.1) | 1,057 (32.7) | 1,040 (33.5) | 1,082 (34.1) | 1,086 (34.3) | ||
Hospital and clinic | 18 (0.3) | 14 (0.4) | 4 (0.1) | 9 (0.3) | 10 (0.3) |
Unadjusted |
p-value | Adjusted by IPTW |
p-value | |
---|---|---|---|---|
OR (95% CI) | OR (95% CI) | |||
Intraoperative complications | 0.73 (0.63-0.86) | < 0.001 | 0.80 (0.72-0.90) | 0.008 |
Postoperative complications | 0.97 (0.87-1.07) | 0.525 | 0.87 (0.80-0.95) | 0.002 |
Surgical site complications | 0.73 (0.60-0.88) | 0.001 | 0.75 (0.66-0.86) | < 0.001 |
Medical complications | 0.88 (0.79-0.98) | 0.018 | 0.99 (0.90-1.08) | 0.739 |
Blood transfusions | 0.28 (0.25-0.31) | < 0.001 | 0.30 (0.28-0.33) | < 0.001 |
Postoperative adjuvant therapy | 0.59 (0.52-0.67) | < 0.001 | 0.63 (0.57-0.69) | < 0.001 |
Radiation only | 0.92 (0.76-1.11) | 0.387 | 0.87 (0.76-0.99) | 0.042 |
Chemotherapy only | 0.48 (0.41-0.56) | < 0.001 | 0.55 (0.49-0.61) | < 0.001 |
CCRT | 0.44 (0.39-0.49) | < 0.001 | 0.47 (0.43-0.51) | < 0.001 |
All-cause mortality | Unadjusted |
Adjusted by IPTW |
Adjusted by IPTW and PoAT |
|||
---|---|---|---|---|---|---|
HR (95% CI) | p-value | HR (95% CI) | p-value | HR (95% CI) | p-value | |
Total | 0.52 (0.43-0.63) | < 0.001 | 0.61 (0.53-0.70) | < 0.001 | 0.74 (0.64-0.85) | < 0.001 |
With adjuvant therapy | 0.71 (0.56-0.90) | 0.005 | 0.85 (0.72-0.99) | 0.046 | - | - |
Without adjuvant therapy | 0.48 (0.34-0.67) | < 0.001 | 0.52 (0.41-0.66) | < 0.001 | - | - |
RH, radical hysterectomy; CCI, Charlson comorbidity index. Frequency numbers were rounded to integers based on weight, The p-values were derived from the chi-square test, The p-values were derived from weighted survey logistic model.
IPTW, inverse probability of treatment weighting; OR, odds ratio; CI, confidence interval; CCRT, concurrent chemoradiation.
IPTW, inverse probability of treatment weighting; PoAT, postoperative adjuvant therapy; HR, hazard ratio; CI, confidence interval.