Department of Urology, Klinikum Nuremberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany.
World J Urol. 2020 Oct;38(10):2523-2530. doi: 10.1007/s00345-019-03052-7. Epub 2019 Dec 13.
To validate the adherence of urologists to chemotherapy recommendations given in the EAU guidelines on PeCa. The European Association of Urology (EAU) guidelines on penile cancer (PeCa) are predominantly based on retrospective studies with low level of evidence.
A 14-item-survey addressing general issues of PeCa treatment was developed and sent to 45 European hospitals. 557 urologists participated in the survey of which 43.5%, 19.3%, and 37.2% were in-training, certified, and in leading positions, respectively. Median response rate among participating departments was 85.7% (IQR 75-94%). Three of 14 questions addressed clinical decisions on neoadjuvant, adjuvant, and palliative chemotherapy. Survey results were analyzed by bootstrap-adjusted multivariate logistic-regression-analysis to identify predictors for chemotherapy recommendations consistent with the guidelines.
Neoadjuvant, adjuvant, and palliative chemotherapy was recommended according to EAU guidelines in 21%, 26%, and 48%, respectively. For neoadjuvant chemotherapy, urologists holding leading positions or performing chemotherapy were more likely to recommend guideline-consistent treatment (OR 1.85 and 1.92 with p = 0.007 and 0.003, respectively). Supporting resources (i.e., guidelines, textbooks) were used by 23% of survey participants and significantly improved consistency between treatment recommendations and Guideline recommendations in all chemotherapy settings (p = 0.010-0.001). Department size and university center status were no significant predictors for all three endpoints.
In this study, we found a very low rate of adherence to the EAU guidelines on systemic treatment for PeCa. Further investigations are needed to clarify whether this missing adherence is a consequence of limited individual knowledge level or of the low grade of guideline recommendations.
验证泌尿科医生对欧洲泌尿外科学会（EAU）关于阴茎癌（PeCa）指南中化疗建议的遵守情况。EAU 关于阴茎癌的指南主要基于低水平证据的回顾性研究。
开发了一个包含 PeCa 治疗一般问题的 14 项调查，并分发给 45 家欧洲医院。共有 557 名泌尿科医生参与了这项调查，其中 43.5%、19.3%和 37.2%分别处于培训中、认证中和担任领导职位。参与部门的中位回复率为 85.7%（IQR 75-94%）。其中 3 个问题涉及新辅助、辅助和姑息化疗的临床决策。通过 bootstrap 调整的多变量逻辑回归分析来分析调查结果，以确定与指南一致的化疗建议的预测因素。
新辅助、辅助和姑息化疗的推荐率分别为 21%、26%和 48%，符合 EAU 指南。对于新辅助化疗，担任领导职务或进行化疗的泌尿科医生更有可能推荐符合指南的治疗方法（OR 分别为 1.85 和 1.92，p=0.007 和 0.003）。支持资源（即指南、教科书）的使用比例为 23%，并显著提高了所有化疗环境下治疗建议与指南建议的一致性（p=0.010-0.001）。部门规模和大学中心地位并不是所有三个终点的显著预测因素。
在这项研究中，我们发现对 EAU 关于阴茎癌系统治疗指南的遵循率非常低。需要进一步研究以明确这种缺失的遵循是否是由于个体知识水平有限还是指南建议的低水平所致。
