Department of Radiation Oncology and Nuclear Medicine, Medizinisches Versorgungszentrum am Klinikum Rosenheim, Rosenheim, Germany.
Tumor Center, Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany.
Arch Gynecol Obstet. 2022 Jan;305(1):203-213. doi: 10.1007/s00404-021-06140-5. Epub 2021 Jul 5.
Treatment according to guidelines has been demonstrated to improve survival in a number of different cancer entities. Deviations from guidelines depend on several factors, including the patient's preferences, age and comorbidities. The aim of this study was to assess the adherence to guideline recommendations concerning surgical and adjuvant treatment in endometrial cancer. Furthermore, we sought to evaluate the reasons for non-adherence to guidelines by further examining the influence of comorbidities and age.
The influence of age, comorbidities, tumor stage and histological subtype on guideline adherence was evaluated by multivariable logistic regression in a cohort of 353 high-grade endometrial cancer patients. High-grade endometrial cancer was defined as carcinosarcoma, Type II (serous, clear cell, mixed cell carcinoma) and Type I G3 histology.
Extensive surgical procedures, particularly systematic LNE, were less frequently applied in patients with comorbidities (p = 0.015) or higher age (p < 0.01). Guideline adherence was not affected by comorbidities (p = 0.563), but was significantly reduced with higher age (p < 0.01). In a multivariable model, higher age (p < 0.01), obesity (p = 0.011), higher FIGO Stage (p < 0.01) and histologic subtype (p < 0.01) significantly decreased OS. Surgery (p < 0.001), chemotherapy (p < 0.01) and systematic LNE (p = 0.011) were associated with higher OS.
Age seems to be the strongest independent factor leading to guideline deviation. Comorbidities were associated with less aggressive treatment, but not with deviations from guidelines.
多项研究已证实，遵循指南进行治疗可改善多种不同癌症实体的生存率。对指南的偏离取决于多个因素，包括患者的偏好、年龄和合并症。本研究旨在评估子宫内膜癌手术和辅助治疗指南建议的遵循情况。此外，我们通过进一步研究合并症和年龄的影响，试图评估不遵循指南的原因。
通过多变量逻辑回归分析，评估了年龄、合并症、肿瘤分期和组织学亚型对 353 例高级别子宫内膜癌患者指南遵循情况的影响。高级别子宫内膜癌定义为癌肉瘤、Ⅱ型（浆液性、透明细胞性、混合细胞癌）和Ⅰ型 G3 组织学。
有合并症（p=0.015）或年龄较高（p<0.01）的患者较少接受广泛的手术，特别是系统淋巴结清扫术。指南的遵循不受合并症的影响（p=0.563），但与年龄较高显著相关（p<0.01）。在多变量模型中，年龄较高（p<0.01）、肥胖（p=0.011）、FIGO 分期较高（p<0.01）和组织学亚型（p<0.01）显著降低了总生存期。手术（p<0.001）、化疗（p<0.01）和系统淋巴结清扫术（p=0.011）与较高的总生存期相关。
年龄似乎是导致指南偏离的最强独立因素。合并症与治疗不积极相关，但与不遵循指南无关。
