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05.07.2021 | Gynecologic Oncology

Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study

verfasst von: Sophia Scharl, Tim Sprötge, Michael Gerken, Anton Scharl, Atanas Ignatov, Elisabeth C. Inwald, Olaf Ortmann, Oliver Kölbl, Monika Klinkhammer‑Schalke, Thomas Papathemelis

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 1/2022

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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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Titel: Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study
verfasst von: Sophia Scharl
Tim Sprötge
Michael Gerken
Anton Scharl
Atanas Ignatov
Elisabeth C. Inwald
Olaf Ortmann
Oliver Kölbl
Monika Klinkhammer‑Schalke
Thomas Papathemelis
Publikationsdatum: 05.07.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 1/2022
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-021-06140-5

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Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study