Eisenkop S M, Spirtos N M
Womens' Cancer Center, Encino-Tarzana, 5525 Etiwanda Avenue, Suite 311, Tarzana, California 91356, USA.
Gynecol Oncol. 2001 Sep;82(3):489-97. doi: 10.1006/gyno.2001.6312.
The purpose of this survey was to determine the range of surgical objectives, strategies, and outcomes of primary cytoreductive operations performed by gynecologic oncologists.
A survey addressing the definition of "optimal" cytoreduction, the use of neoadjuvant chemotherapy, disease sites precluding optimal cytoreduction, reasons optimal cytoreduction or cytoreduction to a visibly disease-free outcome is or is not accomplished, the use of 15 specific operative procedures, and attitude toward postfellowship training in the surgical management of advanced stage epithelial ovarian cancer was mailed to candidate and full members of the Society of Gynecologic Oncologists. Analysis of discrete and binomial data utilized the chi(2) and independent samples t tests. Logistic regression confirmed relationships between responses and both the definition of optimal cytoreduction and the attitudes toward postfellowship training.
Three hundred ninety-three (61.4%) of 640 physicians provided utilizable data. A median of 95% of patients were reported to be operated on primarily and 5% were treated with neoadjuvant chemotherapy (P < 0.0001). A median of 9 (range 0-15) of the surveyed procedures were utilized. Forty-seven (12.0%) respondents defined optimal cytoreduction as no residual disease, 54 (13.7%) used a 5-mm threshold, 239 (60.8%) used a 1-cm threshold, and 48 (12.6%) utilized a 1.5- to 2.0-cm threshold. Small dimensions of residual disease (0-5 mm versus 1-2 cm) defined optimal cytoreduction for physicians indicating that fewer disease sites precluded optimal cytoreduction (P = 0.02), using a larger number of the surveyed procedures (P = 0.04), and in practice longer (P = 0.001). Three hundred seventeen (83.9%) of 378 respondents favored development of postfellowship training in cytoreductive surgery. Physicians against postfellowship training used fewer of the surveyed procedures because of concerns about efficacy (P = 0.01). More recent fellowship graduates favored postfellowship training (P = 0.01).
A range of surgical objectives, strategies, procedures used, and outcomes exists among gynecologic oncologists. Confirmation of the efficacy of cytoreductive surgery may cultivate a consensus about the most appropriate therapeutic objective and strategy for advanced ovarian cancer. Cooperative efforts should be undertaken to offer postfellowship training.
本调查旨在确定妇科肿瘤学家进行的原发性细胞减灭术的手术目标、策略及结果范围。
一项关于“最佳”细胞减灭术的定义、新辅助化疗的使用、妨碍最佳细胞减灭术的疾病部位、实现或未实现最佳细胞减灭术或减瘤至肉眼无病状态的原因、15种特定手术操作的使用情况以及对晚期上皮性卵巢癌手术管理中毕业后培训态度的调查，已邮寄给妇科肿瘤学家协会的候选成员和正式成员。对离散数据和二项式数据的分析采用卡方检验和独立样本t检验。逻辑回归证实了反应与最佳细胞减灭术定义以及毕业后培训态度之间的关系。
640名医生中有393名（61.4%）提供了可用数据。据报告，中位比例为95%的患者接受了主要手术治疗，5%的患者接受了新辅助化疗（P<0.0001）。所调查的手术操作中位使用数量为9种（范围0 - 15种）。47名（12.0%）受访者将最佳细胞减灭术定义为无残留疾病，54名（13.7%）使用5毫米阈值，239名（60.8%）使用1厘米阈值，48名（12.6%）使用1.5至2.0厘米阈值。对于将残留疾病小尺寸（0 - 5毫米与1 - 2厘米）定义为最佳细胞减灭术的医生而言，表明妨碍最佳细胞减灭术的疾病部位更少（P = 0.02），使用的所调查手术操作更多（P = 0.04），且实际操作时间更长（P = 0.001）。378名受访者中有317名（83.9%）赞成开展细胞减灭术的毕业后培训。反对毕业后培训的医生因担心疗效而使用的所调查手术操作较少（P = 0.01）。近期毕业的学员更赞成毕业后培训（P = 0.01）。
妇科肿瘤学家在手术目标、策略、使用的手术操作及结果方面存在一定范围差异。细胞减灭术疗效的确证可能会就晚期卵巢癌最合适的治疗目标和策略达成共识。应共同努力提供毕业后培训。
