Hansinger Judith, Völkel Vinzenz, Gerken Michael, Schoffer Olaf, Wimberger Pauline, Bierbaum Veronika, Bobeth Christoph, Rößler Martin, Dröge Patrik, Ruhnke Thomas, Günster Christian, Tol Kees Kleihues-van, Link Theresa, Kast Karin, Papathemelis Thomas, Ortmann Olaf, Schmitt Jochen, Klinkhammer-Schalke Monika
Tumorzentrum Regensburg, Zentrum für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Germany.
Bavarian Cancer Research Center (BZKF), Regensburg, Germany.
Geburtshilfe Frauenheilkd. 2024 Oct 1;84(10):979-988. doi: 10.1055/a-1869-2060. eCollection 2024 Oct.
Endometrial cancer is the most common malignant tumor of the female genital organs. In Germany, treatment is provided in both cancer centers certified by the German Cancer Society (Deutsche Krebsgesellschaft, DKG) and in non-certified hospitals. This study investigated whether treatment in DKG-certified centers leads to improved overall survival of patients with endometrial cancer. Data from 11 legally independent German statutory health insurance (SHI) funds of the AOK were analyzed as well as data from four clinical cancer registries (CCR), resulting in inclusion of 30 102 AOK patients and 8190 registry patients with a diagnosis (incidental cases) of ICD-10-GM code C54 (malignant neoplasm of corpus uteri). For comparative survival analyses, multivariable Cox regressions and Kaplan-Meier analyses were used. The Kaplan-Meier estimator for 5-year overall survival was 66.7% for patients from certified centers and 65.0% for patients from non-certified hospitals (using SHI data; CCR data: 63.4% vs. 60.7%). Cox regression adjusted for relevant confounders showed a hazard ratio (HR) of 0.93 (SHI data; 95% CI 0.86 - 1.00; p = 0.050) and 0.935 (CCR data; 95% CI 0.827 - 1.057; p = 0.281) for all-cause mortality. In a subgroup analysis (CCR), patients with International Union against Cancer Control (UICC) stage I had a significant survival benefit if treated in a certified center (HR 0.783; 95% CI 0.620 - 0.987; p = 0.038). The study presented herein shows that patients with endometrial cancer treated in a certified cancer center tend to have better survival rates. This should be considered when selecting the treating hospital.
子宫内膜癌是女性生殖器官最常见的恶性肿瘤。在德国，德国癌症协会（Deutsche Krebsgesellschaft，DKG）认证的癌症中心和非认证医院均提供治疗。本研究调查了在DKG认证中心接受治疗是否能提高子宫内膜癌患者的总生存率。分析了来自AOK的11个具有法律独立性的德国法定健康保险（SHI）基金的数据以及来自四个临床癌症登记处（CCR）的数据，结果纳入了30102例AOK患者和8190例诊断为ICD-10-GM编码C54（子宫体恶性肿瘤）的登记患者（偶发病例）。为了进行比较生存分析，使用了多变量Cox回归和Kaplan-Meier分析。认证中心患者的5年总生存率的Kaplan-Meier估计值为66.7%，非认证医院患者为65.0%（使用SHI数据；CCR数据：63.4%对60.7%）。针对相关混杂因素进行调整后的Cox回归显示，全因死亡率的风险比（HR）为0.93（SHI数据；95%CI 0.86 - 1.00；p = 0.050）和0.935（CCR数据；95%CI 0.827 - 1.057；p = 0.281）。在亚组分析（CCR）中，国际抗癌联盟（UICC）I期患者在认证中心接受治疗有显著的生存获益（HR 0.783；95%CI 0.620 - 0.987；p = 0.038）。本文呈现的研究表明，在认证癌症中心接受治疗的子宫内膜癌患者往往有更好的生存率。在选择治疗医院时应考虑这一点。
