Department of Health Services Administration, School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico; Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.
Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States.
Cancer Epidemiol. 2024 Dec;93:102664. doi: 10.1016/j.canep.2024.102664. Epub 2024 Sep 19.
Endometrial cancer poses a significant health concern in Puerto Rico, where it ranks as the primary gynecological malignancy among women. This study evaluates concordance with the National Comprehensive Cancer Network (NCCN) guidelines for endometrial cancer first treatment in Puerto Rican women and its association with 5-year overall survival.
Data on patients with endometrial cancer diagnosed between 2009 and 2015 was obtained from the Puerto Rico Central Cancer Registry, which is linked to the Puerto Rico Health Insurance Linkage database (n = 2114). The association between receiving guideline-concordant first treatment and clinical, socioeconomic, and health system factors was evaluated using logistic regression. The 5-year overall survival was calculated using the Kaplan-Meier method. Cox proportional hazard regression models were used to estimate hazard ratios and 95 % confidence intervals (CIs) for associations between guideline-concordant first treatment and overall survival.
In our cohort, 53.9 % of patients received guideline-concordant first treatment. Receiving care at a Commission on Cancer-accredited center, being evaluated by a gynecologist-oncologist, and possessing private insurance enhanced the likelihood of receiving guideline-concordant first treatment. In the Cox regression models, receiving guideline-concordant first treatment was associated with a lower mortality risk (HR: 0.72, 95 % CI: 0.59-0.89).
Guideline-concordant first treatment is a strong predictor of improved survival rates in endometrial cancer. Given that guidelines based on scientific evidence have been demonstrated to enhance patient outcomes, we must understand and promote the factors contributing to their adoption.
子宫内膜癌是波多黎各女性面临的一个重大健康问题，它是女性中主要的妇科恶性肿瘤。本研究评估了波多黎各女性子宫内膜癌首次治疗与国家综合癌症网络（NCCN）指南的一致性及其与 5 年总生存率的关系。
从波多黎各中央癌症登记处获取了 2009 年至 2015 年间诊断为子宫内膜癌的患者数据，该登记处与波多黎各健康保险链接数据库相关联（n=2114）。使用逻辑回归评估接受指南一致的首次治疗与临床、社会经济和卫生系统因素之间的关系。使用 Kaplan-Meier 方法计算 5 年总生存率。使用 Cox 比例风险回归模型估计指南一致的首次治疗与总生存率之间的关联的风险比和 95%置信区间（CI）。
在我们的队列中，53.9%的患者接受了指南一致的首次治疗。在经过癌症委员会认证的中心接受治疗、由妇科肿瘤学家评估以及拥有私人保险可提高接受指南一致的首次治疗的可能性。在 Cox 回归模型中，接受指南一致的首次治疗与死亡率降低相关（HR：0.72，95%CI：0.59-0.89）。
指南一致的首次治疗是子宫内膜癌生存率提高的有力预测因素。鉴于基于科学证据的指南已被证明可以改善患者的结局，我们必须了解并促进有助于其采用的因素。
