J Gynecol Oncol.  2017 Nov;28(6):e76. 10.3802/jgo.2017.28.e76.

Assessing the effect of guideline introduction on clinical practice and outcome in patients with endometrial cancer in Japan: a project of the Japan Society of Gynecologic Oncology (JSGO) guideline evaluation committee

• Shigeta S
• Nagase S
• Mikami M
• Ikeda M
• Shida M
• Sakaguchi
• Ushioda N
• Takahashi
• Yamagami W
• Yaegashi N
• Udagawa Y
• Katabuchi

• KMID: 2413202
• DOI: http://doi.org/10.3802/jgo.2017.28.e76

Abstract

OBJECTIVE
The Japan Society of Gynecologic Oncology (JSGO) published the first practice guideline for endometrial cancer in 2006. The JSGO guideline evaluation committee assessed the effect of this guideline introduction on clinical practice and patient outcome using data provided by the Japan Society of Obstetrics and Gynecology (JSOG) cancer registration system.
METHODS
Data of patients with endometrial cancer registered between 2000 and 2012 were analyzed, and epidemiological and clinical trends were assessed. The influence of guideline introduction on survival was determined by analyzing data of patients registered between 2004 and 2009 using competing risk model.
RESULTS
In total, 65,241 cases of endometrial cancer were registered. Total number of patients registered each year increased about 3 times in the analyzed period, and the proportion of older patients with type II endometrial cancer rapidly increased. The frequency of lymphadenectomy had decreased not only among the low-recurrence risk group but also among the intermediate- or high-recurrence risk group. Adjuvant therapy was integrated into chemotherapy (p<0.001). Overall survival did not significantly differ before and after the guideline introduction (hazard ratio [HR]=0.891; p=0.160). Additional analyses revealed patients receiving adjuvant chemotherapy showed better prognosis than those receiving adjuvant radiation therapy when limited to stage I or II (HR= 0.598; p=0.003).
CONCLUSION
It was suggested that guideline introduction influenced the management of endometrial cancer at several aspects. Better organized information and continuous evaluation are necessary to understand the causal relationship between the guideline and patient outcome.

Keyword

Practice Guideline; Endometrial Neoplasms; Chemotherapy, Adjuvant; Lymph Node Excision; Survival

MeSH Terms

Adenocarcinoma, Clear Cell/pathology/*therapy
Adult
Aged
Aged, 80 and over
Carcinoma, Endometrioid/pathology/*therapy
Chemotherapy, Adjuvant/utilization
Endometrial Neoplasms/pathology/*therapy
Female
Humans
Hysterectomy
Japan
Lymph Node Excision/utilization
Middle Aged
Multivariate Analysis
Neoplasm Staging
Neoplasms, Cystic, Mucinous, and Serous/pathology/*therapy
Outcome Assessment (Health Care)
*Practice Guidelines as Topic
Practice Patterns, Physicians'/*statistics & numerical data
Prognosis
Proportional Hazards Models
Radiotherapy, Adjuvant/utilization
*Registries
Retrospective Studies
Survival Rate

Figure

• 

  Fig. 1. Trends of patient characteristics. (A) Number of patients and facilities per year. (B) Age distribution per year. Patients aged >60 years significantly increased (p<0.001). (C) Histological subtype distribution per year. Trend test revealed significant increases in the frequency of serous adenocarcinoma, and in the population of both serous and clear cell carcinoma (p<0.001).

• 

  Fig. 2. Trends of clinical practice in endometrial cancer management. (A) Distribution of initial treatment by year. Among surgeries, the proportion of LA procedures had significantly decreased (Cochran-Armitage trend test, p<0.001). (B) Trend of adjuvant therapy in each year. The proportion of adjuvant chemotherapy had significantly increased among the adjuvant therapies (Cochran-Armitage trend test, p<0.001). EBRT, extra-beam radiation therapy; ICBT, intracavitary brachytherapy; LA, lymphadenectomy.

Reference

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