Vanbraband Joren, Van Damme Nancy, Silversmit Geert, De Geyndt Anke, Bouche Gauthier, Jacomen Gerd, de Jonge Eric, Goffin Frédéric, Denys Hannelore, Amant Frédéric
Unit of Gynecologic Oncology, Department of Oncology, KU Leuven, Campus Gasthuisberg, ON4 Herestraat 49, Box 1045, 3000 Leuven, Belgium.
Belgian Cancer Registry, Koningsstraat 215, Box 7, 1210 Brussels, Belgium.
Gynecol Oncol. 2024 Jan;180:70-78. doi: 10.1016/j.ygyno.2023.11.015. Epub 2023 Dec 12.
To investigate the practice patterns and quality of care for uterine cancer on a national level in Belgium, including trends in practice over the period 2012-2016.
Quality indicators were measured using the EFFectiveness of Endometrial Cancer Treatment (EFFECT) database. Multivariable logistic mixed regression was used to test for associations between the quality indicators and year of diagnosis, adjusted for potential confounders and intra-cluster correlations.
The EFFECT database includes 4178 patients diagnosed with uterine cancer in the period 2012-2016. Minimally invasive surgery (laparoscopic or robotic-assisted) was applied in 61.6% of patients who had surgery for clinical stage I endometrial carcinoma (EC), increasing from 52.9% in 2012 to 66.4% in 2016. At least pelvic lymph node staging was performed in 69.0% of patients with clinical stage I, high-grade EC; and in 63.9% of patients with clinical stage I-II serous carcinoma, clear cell carcinoma or carcinosarcoma. The latter increased from 48.8% in 2012 to 77.2% in 2016. Adjuvant radiotherapy (external beam and/or brachytherapy) was offered to 33.5% of patients who had surgery without lymph node staging for pathological stage I EC at high-intermediate or high risk of recurrence. Adjuvant chemotherapy was administered to 64.4% of patients with pathological stage III-IVA EC.
Study results indicate an overall good quality of care for patients with uterine cancer in Belgium. Treatment areas with potential room for improvement include the use of minimally invasive surgery, comprehensive surgical staging and adjuvant therapy, which confirms the remaining controversies in uterine cancer treatment and the need for further research.
在比利时全国范围内调查子宫癌的治疗模式和医疗质量，包括2012 - 2016年期间的治疗趋势。
使用子宫内膜癌治疗效果（EFFectiveness of Endometrial Cancer Treatment，EFFECT）数据库来衡量质量指标。采用多变量逻辑混合回归分析，在调整潜在混杂因素和聚类内相关性的情况下，检验质量指标与诊断年份之间的关联。
EFFECT数据库纳入了2012 - 2016年期间诊断为子宫癌的4178例患者。临床I期子宫内膜癌（EC）接受手术治疗的患者中，61.6%采用了微创手术（腹腔镜或机器人辅助手术），该比例从2012年的52.9%增至2016年的66.4%。临床I期、高级别EC患者中，69.0%至少进行了盆腔淋巴结分期；临床I - II期浆液性癌、透明细胞癌或癌肉瘤患者中，63.9%进行了盆腔淋巴结分期。后者从2012年的48.8%增至2016年的77.2%。对于病理I期EC且复发风险为中高或高风险、未进行淋巴结分期而接受手术的患者，33.5%接受了辅助放疗（外照射和/或近距离放疗）。病理III - IVA期EC患者中，64.4%接受了辅助化疗。
研究结果表明比利时子宫癌患者的整体医疗质量良好。仍有改善空间的治疗领域包括微创手术的应用、全面的手术分期和辅助治疗，这证实了子宫癌治疗中仍存在的争议以及进一步研究的必要性。
