h i g h l i g h t s Systematic LND showed no survival benefit vs SLN mapping alone in patients with USC. Detection of nodal metastasis is the same in SLN mapping alone vs systematic LND.

To evaluate the effects of race and insurance status on the use of brachytherapy for treatment of cervical cancer.METHODS: This is a retrospective cohort study of the National Cancer Database. We identified 25,223 patients diagnosed with stage IB2 through IVA cervical cancer who received radiation therapy during their primary treatment from 2004 to 2015. A univariate analysis was used to assess covariate association with brachytherapy. A multivariable regression model was used to evaluate the effect of race and insurance status on rates of brachytherapy treatment. The Cox proportional hazards model and the multiplicative hazard model were used to evaluate overall survival. P,.05 indicated a statistically significant difference for comparisons of primary and secondary outcomes.RESULTS: Non-Hispanic black patients received brachytherapy at a significantly lower rate than non-Hispanic white patients (odds ratio [OR] 0.93; 95% CI 0.86-0.99; P5.036); Hispanic (OR 0.93; 95% CI 0.85-1.02; P5.115) and Asian (OR 1.13; 95% CI 0.99-1.29; P5.074) patients received brachytherapy at similar rates. Compared with patients with private insurance, those who were uninsured (OR 0.72; 95% CI 0.65-0.79; P,.001), had Medicaid (OR 0.83; 95% CI 0.77-0.89; P,.001) or Medicare insurance (OR 0.85; 95% CI 0.78-0.92; P,.001) were less likely to receive brachytherapy. Brachytherapy was not found to be a mediator of race and insurance-related disparities in overall survival.CONCLUSION: Racial and insurance disparities exist for those who receive brachytherapy, with many patients not receiving the standard of care, but overall survival was not affected.

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Highlights Enhanced recovery in gynecologic oncology decreased narcotic usage. Shorter length of hospital stay was also observed in the ERAS cohort. ERAS produced early return of bowel function. The ERAS cohort received less perioperative blood transfusions. A compliance analysis is integral to successful implementation of ERAS.

Chemotherapy is often ineffective in advanced stage and aggressive histologic subtypes of endometrial cancer. Overexpression of the receptor tyrosine kinase AXL has been found to be associated with therapeutic resistance, metastasis, and poor prognosis. However, the mechanism of how inhibition of AXL improves response to chemotherapy is still largely unknown. Thus, we aimed to determine whether treatment with AVB-500, a selective inhibitor of GAS6-AXL, improves endometrial cancer cell sensitivity to chemotherapy particularly through metabolic changes. We found that both GAS6 and AXL expression were higher by immunohistochemistry in patient tumors with a poor response to chemotherapy compared to tumors with a good response to chemotherapy. We showed that chemotherapy resistant endometrial cancer cells (ARK1, uterine serous carcinoma and PUC198, grade 3 endometrioid adenocarcinoma) had improved sensitivity and synergy with paclitaxel and carboplatin when treated in combination with AVB-500. We also found that in vivo intraperitoneal models with ARK1 and PUC198 cells had decreased tumor burden when treated with AVB-500 + paclitaxel compared to paclitaxel alone. Treatment with AVB-500 + paclitaxel decreased AKT signaling which resulted in a decrease in basal glycolysis. Finally, multiple glycolytic metabolites were lower in the tumors treated with AVB-500 + paclitaxel than in tumors treated with paclitaxel alone. Our study provides strong pre-clinical rationale for combining AVB-500 with paclitaxel in aggressive endometrial cancer models

INTRODUCTION: Blood loss and subsequent blood transfusion is a common complication in benign gynecologic surgery that has been understudied. The purpose of this study is to identify risk factors associated with peri-operative blood transfusion and highlight those that are modifiable for abdominal and vaginal hysterectomy. METHODS: Using a retrospective study design between 1/1/2008 and 4/30/2014, 562 of 667 hysterectomies were included. Hysterectomies performed peripartum or for cancer were excluded. Risk factors examined include race, pre-operative hemoglobin, body mass index (BMI), surgical route, and uterine size. Comparisons between subgroups were performed using Chi-square or Wilcoxon test. Blood transfusion rate, odds ratio (OR) of transfusion and its 95% confidence interval (CI) were reported. Multiple logistic regression was used to identify potential risk factors for peri-operative blood transfusion. RESULTS: The overall transfusion rate was 13.3% (75/562) and differed for abdominal versus vaginal hysterectomy (18.0% vs. 6.8% P < .001). Pre-operative hemoglobin less than 10.6 g/dL versus greater than or equal to 13.1 g/dL had five times the odds of transfusion (95% CI 2.4-13.5). Uterus size greater than 470 gm versus less than or equal to 108 gm had fourfold odds of transfusion (95% CI 1.5-14.3). African Americans had twice the odds of transfusion (95% CI 1.2-4.5), despite controlling for increased uterus size and lower hemoglobin. There was no statistically significant association between BMI and transfusion. CONCLUSION: This study identified lower pre-operative hemoglobin, larger uterus size, and African American race as three important risk factors. Prior to hysterectomy, hemoglobin should be optimized above 13.1 g/dL, especially for patients with large uteri and African Americans.

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