Carney Michael E, Lancaster Johnathan M, Ford Clyde, Tsodikov Alexander, Wiggins Charles L
Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah 84198, USA.
Gynecol Oncol. 2002 Jan;84(1):36-42. doi: 10.1006/gyno.2001.6460.
To determine the fraction of patients diagnosed with ovarian cancer and seen by a gynecologic oncologist and to compare outcomes with those patients and others who are not seen by a gynecologic oncologist.
The statewide, population-based Utah Cancer Registry was used to identify 848 patients diagnosed with epithelial ovarian cancer between 1992 and 1998. Differences between selected characteristics of cases seen/not seen by gynecologic oncologists were assessed with chi2 tests, and survival data were analyzed using Kaplan-Meier curves and log-rank testing.
Of 848 incident epithelial ovarian cancer cases diagnosed in Utah residents during the period 1992-1998, 333 (39.3%) were seen by a gynecologic oncologist at some time during their cancer diagnosis and/or treatment. The percentage of ovarian cancer cases seen by a gynecologic oncologist varied with age: 35.6% of cases under 40 years of age at diagnosis were seen by a gynecologic oncologist, as were 54.5% of cases 40-59 years of age, 42.6% of cases 60-69 years, and 23.7% of women 70+ years of age (chi2 test, P < 0.01). The percentage of ovarian cancer cases seen by a gynecologic oncologists increased during the study period, from 33.0% in 1992-1993 to 47.5% in 1997-1998 (chi2 test for trend, P < 0.01). The vast majority of the state's population resides within a contiguous, four-county area near the only major city where gynecologic oncology care is available. Ovarian cancer cases that resided within that geographic area were generally more likely to have been seen by a gynecologic oncologist than those who lived in more rural regions of the state (42.7 and 27.1%, respectively; chi2 test, P < 0.01). For ovarian cancer cases diagnosed with local or regional stages of disease, there were no significant differences in survivorship between those treated or not treated by gynecologic oncologists. Among cases diagnosed with advanced disease, those cases seen by gynecologic oncologists had a significant survival advantage when compared to those that were not (median survival 26 and 15 months, respectively, P < 0.01).
Gynecologic oncologists see less than half of ovarian cancer patients. Patients under 40 years of age, over 70 years of age, and in rural areas were significantly less likely to be seen by a gynecologic oncologist in their course of treatment. Patients with advanced disease experienced a significant survival advantage when a gynecologic oncologist was involved in their care.
确定被诊断为卵巢癌且由妇科肿瘤学家诊治的患者比例，并将这些患者的治疗结果与未由妇科肿瘤学家诊治的患者进行比较。
利用基于全州人口的犹他州癌症登记处，识别出1992年至1998年间被诊断为上皮性卵巢癌的848例患者。通过卡方检验评估妇科肿瘤学家诊治/未诊治病例的选定特征之间的差异，并使用Kaplan-Meier曲线和对数秩检验分析生存数据。
在1992 - 1998年期间，犹他州居民中确诊的848例上皮性卵巢癌新发病例中，333例（39.3%）在癌症诊断和/或治疗的某个阶段由妇科肿瘤学家诊治。由妇科肿瘤学家诊治的卵巢癌病例百分比随年龄而异：诊断时年龄在40岁以下的病例中，35.6%由妇科肿瘤学家诊治；40 - 59岁的病例中，这一比例为54.5%；60 - 69岁的病例中为42.6%；70岁及以上女性中为23.7%（卡方检验，P < 0.01）。在研究期间，由妇科肿瘤学家诊治的卵巢癌病例百分比有所增加，从1992 - 1993年的33.0%增至1997 - 1998年的47.5%（趋势卡方检验，P < 0.01）。该州绝大多数人口居住在唯一提供妇科肿瘤治疗的主要城市附近一个相邻的四县地区内。居住在该地理区域内的卵巢癌病例比居住在该州更偏远农村地区的病例更有可能由妇科肿瘤学家诊治（分别为42.7%和27.1%；卡方检验，P < 0.01）。对于诊断为局部或区域疾病阶段的卵巢癌病例，由妇科肿瘤学家治疗或未治疗的患者在生存率方面没有显著差异。在诊断为晚期疾病的病例中，与未由妇科肿瘤学家诊治的病例相比，由妇科肿瘤学家诊治的病例具有显著的生存优势（中位生存期分别为26个月和15个月，P < 0.01）。
妇科肿瘤学家诊治的卵巢癌患者不到一半。40岁以下、70岁以上以及农村地区的患者在治疗过程中由妇科肿瘤学家诊治的可能性显著较低。当妇科肿瘤学家参与晚期疾病患者的治疗时，这些患者具有显著的生存优势。
