Preparing for a paradigm shift in the treatment of ovarian cancer: Effect of online CME on oncologists' knowledge and competence

Abstract

centers were defined as hospitals that completed more cases than the median for each year in the dataset. We compared patient characteristics, procedures, and outcomes, and examined trends over the 5-year period. A multivariable analysis (MVA) was completed to identify independent predictors of surgical complications in the robotic cohort. Results: A total of 7,066 patients were identified. Over the study period, rates of obesity increased (P b .001) as well as the CCI (P = .001). Lymph node dissection was less commonly performed (P b .001). Surgery volume increased in small or medium-sized (P b .001), private (P b .001), and teaching (P b0.001) hospitals. High-volume centers were more likely to be large (74% vs 62%, P b .001), teaching hospitals (78% vs 58%, P b .001), located in the northeastern or western United States, and were less likely to be privately owned (22% vs 31%, P b .001). Patients treated at highvolume centers were similar in age (P = .11), but had higher CCI values (2.5 ± 0.9 vs 2.6 ± 1.2, P = .002) and were more likely to undergo lymph node dissection (73% vs 68%, P = .007). MVA models included age, race, CCI, obesity, lymph node dissection, hospital size, ownership, teaching status, location, and volume. Increasing age (adjusted odds ratio [aOR] 1.02; 95% CI 1.02-1.03), CCI (aOR 1.25, 95% CI 1.18-1.33), obesity (aOR 1.50, 95% CI 1.30-1.73), and teaching hospital (aOR 1.23, 95% CI 1.05-1.45) independently predicted having a surgical complication. Large (aOR 0.85, 95% CI 0.74-0.99) or high-volume (aOR 0.81, 95% CI 0.66-0.98) hospital and Caucasian race (aOR 0.84, 95% CI 0.71-0.99) were associated with lower risk of complication. With increasing year of the procedure, patients were less likely to have a surgical complication (aOR 0.86, 95% CI 0.81-0.91). Conclusions: The strongest independent predictor of improved intraoperative and perioperative outcomes in robotic surgery for endometrial cancer is having surgery at a high-volume center.Objectives: Expression of AXL is associated with a worse prognosis in ovarian cancer. We investigated the role of AXL expression in chemotherapy response in ovarian and uterine cancers, and sought to reverse chemoresistance through inactivation of AXL. Methods: In vitro cell viability (XTT) assays were performed to confirm response to chemotherapy in SKOV3-S/R (platinum sensitive/ resistant ovarian cell lines), OVCAR3/TP (taxane sensitive/resistant ovarian cell lines), and AN3CA/ARK1 (taxane sensitive/resistant uterine cell lines), and Western blotting was performed for AXL expression. XTT assays of ARK1 cells for paclitaxel resistance with AXL silencing by shRNA were performed. This was then repeated with selective small molecule inhibition of AXL with R428. AXL knockdown by siRNA was performed with either a traditional transfection reagent (DharmaFECT) or with a novel serum-stable, cell-penetrating, endosomolytic amphipathic peptide delivery system (p5RHH). Cell viability assays were analyzed using paired t tests. P b .05 was considered statistically significan...