Olaitan A, Weeks J, Mocroft A, Smith J, Howe K, Murdoch J
Department of Gynaecological Oncology, St Michael's Hospital, Southwell Street, Bristol, BS2 8EG, UK.
Br J Cancer. 2001 Dec 14;85(12):1824-30. doi: 10.1054/bjoc.2001.2196.
The surgical management of epithelial ovarian cancer in the South West of England was studied in the two years 1997-1998 in order to determine the factors that influence the outcome of surgery and to provide a baseline from which to assess the effect of centralisation of cancer services. All hospitals in the South West region of England participating in the Regional Cancer Organisation's longitudinal study of outcomes in gynaecological malignancies are included. Six hundred and eighty-two patients with epithelial ovarian cancer were registered with the RCO in the two-year study period. Five hundred and ninety-five women were offered primary cytoreductive surgery of which 438 were said to be optimally cytoreduced. Applying multivariate models to analyse the outcome of surgery, older patients (OR = 0.82 per 5-year increase in age, P = 0.0003), patients treated in hospitals managing fewer than ten cases of ovarian cancer per year (OR = 1.92, P = 0.02) and patients with FIGO stage 3 (OR = 0.02, P < 0.0001) or 4 (OR = 0.002, P < 0.0001) disease were less likely to be optimally cytoreduced. Gynaecological oncologists were 2.06 times more likely to attain optimal cytoreduction when compared to general gynaecologists and this was statistically significant (P = 0.01). The results from this study support the argument that limiting surgery for ovarian malignancy to specialised surgeons improves the extent of cytoreductive surgery.
为了确定影响手术结果的因素，并提供一个评估癌症服务集中化效果的基线，1997年至1998年的两年间，对英格兰西南部上皮性卵巢癌的手术治疗情况进行了研究。纳入了英格兰西南部地区所有参与区域癌症组织妇科恶性肿瘤纵向结局研究的医院。在为期两年的研究期间，有682例上皮性卵巢癌患者在区域癌症组织登记。595名女性接受了初次细胞减灭术，其中438例据说是达到了最佳细胞减灭效果。应用多变量模型分析手术结果，年龄较大的患者（年龄每增加5岁，比值比=0.82，P=0.0003）、在每年处理少于10例卵巢癌病例的医院接受治疗的患者（比值比=1.92，P=0.02）以及国际妇产科联盟（FIGO）分期为3期（比值比=0.02，P<0.0001）或4期（比值比=0.002，P<0.0001）疾病的患者达到最佳细胞减灭的可能性较小。与普通妇科医生相比，妇科肿瘤学家实现最佳细胞减灭的可能性高2.06倍，且具有统计学意义（P=0.01）。这项研究的结果支持了这样一种观点，即将卵巢恶性肿瘤手术限制于专科外科医生可提高细胞减灭术的程度。
