Rural–urban differences in surgical treatment, regional lymph node examination, and survival in endometrial cancer patients

Abstract

Purpose: Endometrial cancer (EC) is the most common gynecological malignancy and one of few cancers with an increasing US mortality rate. Rural patients may have less access to specialty care affecting their receipt of surgery and adequate lymphadenectomy (AL). We sought to assess rural–urban differences in EC surgery, lymphadenectomy, and survival. Methods: We analyzed data from the Surveillance Epidemiology and End Results database on EC patients (2004–2013). We performed univariate analyses to compare rural and urban patients on demographic and clinical characteristics and receipt of nodal examination and AL. We assessed rural–urban differences in trends of receipt of AL, performed logistic regression to evaluate differences in receipt of surgery, nodal examination, and AL, and performed survival analysis. Results: Rural patients were less likely to have any lymph nodes removed, had a smaller median number removed, and a smaller proportion had AL. Even after controlling for established risk factors, rural patients had lower odds of lymph node examination and adequate AL than urban patients and also had poorer survival. Conclusions: Future research should continue to assess the association between access to care and disparities in surgical care and the effect of these disparities on survival.