ABSTRACT
OBJECTIVE: To determine whether the Swenson model of postoperative day 1 (POD1) hematocrit after benign hysterectomy is applicable to gynecologic oncology hysterectomies. METHODS: Data were retrospectively collected from cases of hysterectomy with malignant pathology in Hartford, USA, from 2014 to 2016. Predicted POD1 hematocrit was compared with actual hematocrit. ROC curve analysis was used to determine the optimal cut-off point for predicting hematocrit levels of 30% or less. RESULTS: Among 107 women, mean age was 62.9 years and body mass index was 34.0. Most underwent robotic (44.9%) or abdominal (43.9%) hysterectomy. The published equation correctly predicted hematocrit to within ±5% for 83.2% of women, which was less accurate than observed in the original validation set. The equation was more likely to underestimate lower hematocrit levels, adding safety to its use. By ROC curve analysis, the best cut-off point for predicting actual hematocrit above 30% was predicted hematocrit 32.3% (100% specificity). CONCLUSION: The Swenson equation predicted POD1 hematocrit less accurately in the current dataset. As a screening tool for hematocrit below 30%, however, ordering postoperative hematocrit is probably unnecessary if the predicted value is 32.3% or higher. This equation should be used as a screening tool to reduce unnecessary laboratory tests.
Subject(s)
Blood Loss, Surgical , Hematocrit , Hysterectomy , Uterine Neoplasms/surgery , Female , Humans , Middle Aged , Postoperative Period , Predictive Value of Tests , ROC Curve , Retrospective StudiesABSTRACT
PURPOSE: To conduct a prospective study of intraperitoneal radioactive chromic phosphate (32P) versus cyclophosphamide-cisplatin (CP) in women with early ovarian cancer at high risk for recurrence (International Federation of Gynecology and Obstetrics stage Ia or Ib grade 3 or Ic or stage II, no macroscopic residual disease) and to compare cumulative incidence of recurrence, overall survival, and relative toxicity. MATERIALS AND METHODS: A total of 251 patients were randomly assigned to treatment with 32P or CP. Twenty-two (8.7%) were ineligible following centralized pathology review. Of the 229 patients included in the analysis, 110 received 32P, and 119 received CP. RESULTS: The cumulative incidence of recurrence at 10 years was 35% (95% CI, 27% to 45%) for patients receiving 32P and 28% (95% CI, 21% to 38%) for those receiving CP. Patients receiving CP had a recurrence rate 29% lower than that of those receiving 32P (P =.15, two-tail test). The death rate for patients treated with CP was 17% lower than that for patients treated with 32P (difference not significant). Combining both arms, the 10-year cumulative incidence of recurrence for all stage I patients was 27% (95% CI, 20% to 34%) compared with 44% (95% CI, 32% to 56%) for stage II patients (P =.01). Both regimens were reasonably well tolerated, but problems with inadequate distribution (7%) and small-bowel perforation (3%) make the otherwise less toxic 32P less acceptable. CONCLUSION: Although there are no statistically significant differences in survival, the lower cumulative recurrence seen with CP and complications of 32P administration make platinum-based combinations the preferred adjuvant therapy for early ovarian cancer patients at high-risk for recurrence.
