Impact of the Introduction of the S3 Guideline on the Management of Primary Endometrial Cancer: A Comparative Analysis of Cancer Registry Data from Hamburg (2014-2022)
This study evaluated the impact of the 2018 S3 guideline for endometrial cancer on clinical management using cancer registry data from Hamburg. This retrospective cohort study included 2,249 patients with primary endometrial cancer (2014-2022), divided into a pre-guideline group (2014-2017) and a post-guideline (2019-2022) group. Quality indicators included parametrial resection rates, lymphadenectomy utilization, and radiation therapy application. Poisson regression models assessed changes with adjustment for age, treatment center, and tumor grading. Patients without parametrial resection increased from 88% to 93% [adjusted effect estimate: 1.06, 95% confidence interval (CI)=0.94-1.19]. Patients without lymphadenectomy increased from 76% to 88% [adjusted effect estimate: 1.13, 95%CI=0.93-1.37]. Radiation therapy use increased from 95% to 100%. Changes aligned with guideline recommendations but were not statistically significant. Poorly differentiated tumors showed significantly different treatment patterns. Practice patterns in Hamburg moved closer to S3 Guideline on the Management of Primary Endometrial Cancer after 2018, although statistical significance was not achieved. Improved registry documentation likely contributed to observed trends. Larger studies with longer follow-up are required to clarify the clinical impact of guideline implementation.