Zapardiel Ignacio, Blancafort Claudia, Cibula David, Jaunarena Ibon, Gorostidi Mikel, Gil-Moreno Antonio, De Santiago Javier
*Gynecologic Oncology Unit, La Paz University Hospital, IdiPAZ, Madrid; †Gynecology Department, Dexeus University Institute, Barcelona, Spain; ‡Gynecologic Oncology Center, Department of Gynecology and Obstetrics, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic; §Gynecologic Oncology Unit, Hospital Universitario Donostia, San Sebastian; ∥Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona; and ¶Department of Gynecology, MD Anderson Cancer Center, Madrid, Spain.
Int J Gynecol Cancer. 2017 Jul;27(6):1293-1297. doi: 10.1097/IGC.0000000000001017.
The aim of the study was to analyze the current management of endometrial cancer across Spain and to evaluate the use and applicability of the national and international guidelines.
An electronic 30-question survey was distributed among all Spanish Society of Obstetrics and Gynecology-registered specialists dedicated to gynecologic oncology in Spain by e-mail. Data were collected anonymously and analyzed using SPSS program.
One hundred forty-five (17.8%) surveys were collected. Significant differences were observed between tertiary hospitals and secondary or private hospitals in terms of appropriate (according to European Society of Gynaecologic Oncology guidelines) nodal staging in low-risk cases (96 [95%] vs 27 [61.4%], respectively; P < 0.001), appropriate nodal staging in intermediate-risk cases (96 [95%] vs 39 [88.6%], respectively; P = 0.004), appropriate treatment in advanced-stage cases (63 [67.7%] vs 13 [40.6%], respectively; P < 0.001), and surgical treatment of relapses (87 [93.5%] vs 18 [56.3%], respectively; P = 0.004) but nonsignificant in the rate of complete paraaortic lymphadenectomy performance (82 [81.2%] vs 28 [63.6%], respectively; P = 0.056). Similar results have been observed when comparing centers with less than 20 cases per year to centers with more than 40 cases annually, with significant differences in the management of low-risk and intermediate-risk endometrial cancers.
This cross-sectional study demonstrates a broad heterogeneity of care giving between the clinical national and international guidelines and the actual practice in Spain. Although most of the responders refer to base their endometrial cancer management on Spanish and European Society of Gynaecologic Oncology guidelines (64.1%), many discrepancies have been observed, mainly in the management of intermediate-risk cases and follow-up. It may be caused by the lack of consensus on certain points, lack of facilities in lower case load centers, and also due to disagreement or unawareness on the current knowledge.
本研究旨在分析西班牙子宫内膜癌的当前管理情况，并评估国内和国际指南的应用及适用性。
通过电子邮件向西班牙所有在西班牙妇产科学会注册的妇科肿瘤专科医生发放一份包含30个问题的电子调查问卷。数据进行匿名收集，并使用SPSS程序进行分析。
共收集到145份（17.8%）调查问卷。在低风险病例的适当（根据欧洲妇科肿瘤学会指南）淋巴结分期方面，三级医院与二级或私立医院之间存在显著差异（分别为96例[95%]对27例[61.4%]；P<0.001），中风险病例的适当淋巴结分期（分别为96例[95%]对39例[88.6%]；P = 0.004），晚期病例的适当治疗（分别为63例[67.7%]对13例[40.6%]；P<0.001），以及复发病例的手术治疗（分别为87例[93.5%]对18例[56.3%]；P = 0.004），但在完全主动脉旁淋巴结清扫率方面无显著差异（分别为82例[81.2%]对28例[63.6%]；P = 0.056）。将每年病例数少于20例的中心与每年病例数多于40例的中心进行比较时，观察到类似结果，在低风险和中风险子宫内膜癌的管理方面存在显著差异。
这项横断面研究表明，国内和国际临床指南与西班牙的实际做法之间在医疗护理方面存在广泛的异质性。尽管大多数受访者表示其子宫内膜癌管理基于西班牙和欧洲妇科肿瘤学会指南（64.1%），但仍观察到许多差异，主要存在于中风险病例的管理和随访方面。这可能是由于在某些问题上缺乏共识、低病例量中心缺乏设施，以及对当前知识存在分歧或认识不足所致。
