Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.
Am J Obstet Gynecol. 2021 Mar;224(3):274.e1-274.e10. doi: 10.1016/j.ajog.2020.09.012. Epub 2020 Sep 12.
In June 2013, Ontario Health (Cancer Care Ontario), the agency responsible for advancing cancer care in Ontario, Canada, published practice guidelines recommending that gynecologic oncologists at tertiary care centers manage the treatment of patients with high-grade endometrial cancers. This study examines the effects of this regionalization of care on patient outcomes.
This study aimed to evaluate the impact of the regionalization of surgery for high-grade endometrial cancer on patient and treatment outcomes.
In this retrospective cohort study, patients diagnosed with nonendometrioid high-grade endometrial cancer from 2003 to 2017 were identified using province-wide administrative databases. To allow 6 months for knowledge translation, 2 periods were defined, with January 1, 2014, as the cutoff. Methods for segmented regression were used to test the effect of the guidelines. Multivariable Cox proportional hazards regression was used to evaluate whether regionalization of care had an impact on patient survival.
There were 3518 patients with nonendometrioid high-grade endometrial cancer identified. The case mix as represented by patient comorbidities and the disease stage distribution did not differ significantly between the 2 regionalization periods. There was a significant increase (69%-85%; P<.001) in the proportion of primary surgeries performed by gynecologic oncologists after regionalization, which was not explained by secular trends. After regionalization, the proportion of patients who had surgical staging (50%-63%; P<.001) and the proportion of patients who received adjuvant treatment (65%-71%; P<.001) increased significantly. After adjusting for age, stage, and comorbidities, there was a decrease in the hazard of mortality (hazard ratio, 0.85 [95% confidence interval, 0.73-0.99]; P=.04) after regionalization.
The publication of a regionalization policy for the treatment of high-grade endometrial cancers in Ontario led to an increase in the proportion of surgeries performed by gynecologic oncologists. This also translated into a significant improvement in patient survival.
2013 年 6 月，加拿大安大略省卫生署（安大略癌症护理机构）发布了实践指南，建议三级保健中心的妇科肿瘤学家管理高级别子宫内膜癌患者的治疗。本研究旨在探讨这种护理区域化对患者结局的影响。
本研究旨在评估高级别子宫内膜癌手术区域化对患者和治疗结局的影响。
在这项回顾性队列研究中，使用全省行政数据库确定了 2003 年至 2017 年期间诊断为非子宫内膜样高级别子宫内膜癌的患者。为了留出 6 个月的知识转化时间，定义了两个时期，以 2014 年 1 月 1 日为截止日期。使用分段回归方法来检验指南的效果。多变量 Cox 比例风险回归用于评估护理区域化是否对患者生存产生影响。
共确定了 3518 例非子宫内膜样高级别子宫内膜癌患者。2 个区域化时期的患者合并症和疾病分期分布的病例组合无显著差异。区域化后，妇科肿瘤学家进行的初级手术比例显著增加（69%-85%；P<.001），这不能用时间趋势来解释。区域化后，手术分期患者的比例（50%-63%；P<.001）和接受辅助治疗的患者比例（65%-71%；P<.001）显著增加。在调整年龄、分期和合并症后，区域化后死亡率的危险比降低（0.85 [95%置信区间，0.73-0.99]；P=.04）。
安大略省发布了一项高级别子宫内膜癌治疗区域化政策，导致妇科肿瘤学家进行的手术比例增加。这也显著改善了患者的生存。
