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

Abstract

ObjectiveThe 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.MethodsData 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.ResultsIn 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).ConclusionIt 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.

Impact of lymphadenectomy on the treatment of endometrial cancer using data from the JSOG cancer registry

“…The results of our study support the findings of the SEPAL study. Because chemotherapy is used in most cases in Japan as an adjuvant treatment [ 1 , 2 , 10 ], the results may differ from those reported in Europe and the United States, where adjuvant radiation therapy is administered [ 11 , 12 ]. The control of pelvic lesions by adjuvant radiation therapy was replaced by regional LN dissection, and further control of systemic lesions by chemotherapy may lead to a prolonged prognosis [ 13 ].…”

“…The standard treatments for endometrial cancer include total hysterectomy, bilateral salpingooophorectomy, and regional lymphadenectomy. In Japan, regional lymphadenectomy is performed in approximately 60–70% of patients with endometrial cancer [ 2 ]; of these, only a few cases have lymph node (LN) metastasis. Regional LN metastasis is one of the most important prognostic factors in endometrial cancer.…”

lncRNA RHPN1‐AS1 promotes the progression of endometrial cancer through the activation of ERK/MAPK pathway

“…Endometrial cancer (EC) is the most common gynecologic malignancies in women, and the patients number is increasing year by year. 1,2 Although surgery is the primary therapeutic strategy for EC patients in recent years, its effectiveness is generally unsatisfactory. 3 Up to now, the etiology and pathogenesis of EC remain unknown.…”

The Clinical Features of Recurrent Endometrial Cancer in Japan: Chemotherapy Instead of Radiotherapy as Postoperative Adjuvant Treatment

“…13 Therefore, among various adjuvant treatments, the use of adjuvant CT significantly increased from 2000 to 2012. 10,11 Therefore, the recurrence patterns, sites, treatments, and prognoses of patients who undergo CT are likely to differ from those of patients involved in previous studies that mostly reported recurrence after radiation. In the present study, we retrospectively summarized the clinicopathological features of patients with EC that recurred after complete remission with primary treatment at 3 large hospitals and revealed the recurrence patterns, treatments, and prognoses for recent REC patients in Japan.…”

“…The greatest change was that chemotherapy (CT) has become more widely used than RT as an adjuvant treatment after primary surgery. 10,11 In 2008, Susumu et al reported the results of a prospective randomized study comparing CT and RT as the postoperative treatment conducted in Japan (JGOG2033). 12 Although there were no significant differences in overall survival (OS) and progression-free survival (PFS) between the adjuvant CT group and adjuvant RT group in total, both OS and PFS of the CT group were significantly better than those of the RT group in patients with high-intermediate risk.…”