Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusion
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.
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Data availability
The data sets generated and/or analysed during the current study are not publicly available due to preservation of privacy but are available from the corresponding author on reasonable request.
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S.S, A.S., M.K., O.K. and T.P. conceived of the presented idea. T.S. and M.G. collected the data and performed the computations. The manuscript was drafted by S.S. The manuscript was revised by E.I., O.O., A.I., A.S. and O.K. All authors discussed the results and contributed to the final manuscript.
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404_2021_6140_MOESM1_ESM.pptx
Supplementary file1 (PPTX 271 KB) Figure S1: Treatment scheme for high-grade endometrial cancer derived from the German DGGG Guideline 1998. Figure S2: Treatment scheme for high-grade endometrial cancer derived from the German DGGG Guideline 1999. Figure S3: Treatment scheme for high-grade endometrial cancer derived from the German DGGG Guideline 2004. Figure S4: Treatment scheme for high-grade endometrial cancer derived from the German DGGG Guideline 2006. Figure S5: Treatment scheme for high-grade endometrial cancer derived from the German S2k-Guideline 2008.
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Scharl, S., Sprötge, T., Gerken, M. et al. Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study. Arch Gynecol Obstet 305, 203–213 (2022). https://doi.org/10.1007/s00404-021-06140-5
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DOI: https://doi.org/10.1007/s00404-021-06140-5