Skinner Kristin A, Helsper James T, Deapen Dennis, Ye Wei, Sposto Richard
Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California/Keck School of Medicine, Los Angeles, California, USA.
Ann Surg Oncol. 2003 Jul;10(6):606-15. doi: 10.1245/aso.2003.06.017.
Many believe that breast cancer should be treated by specialists. We studied the effect of surgeon and hospital specialization on survival after breast cancer treatment in a large, well-defined patient population.
The Cancer Surveillance Program database for Los Angeles County was reviewed. Between 1990 and 1998, 43,411 cases of breast cancer were diagnosed, of which 29,666 had complete data on surgeon, hospital, and staging information. Patients were stratified on the basis of surgeon and hospital specialization, as well as by age, race, stage, surgical procedure, and surgeon and hospital case volume. An analysis of survival and its dependence on these factors was performed.
Age, race, socioeconomic status, tumor size, nodal status, extent of disease, surgeon specialization, surgeon case volume, and hospital case volume were all associated with 5-year survival after diagnosis of breast cancer. Treatment at a specialty center did not affect survival. Multivariate analysis indicated that type of surgeon was an independent predictor of survival (relative risk,.77), as were both hospital and surgeon case volume.
Treatment by a surgical oncologist resulted in a 33% reduction in the risk of death at 5 years. The effect of surgical specialization cannot be entirely attributed to volume effects.
许多人认为乳腺癌应由专科医生治疗。我们在一个大规模、定义明确的患者群体中，研究了外科医生和医院专科化对乳腺癌治疗后生存情况的影响。
回顾了洛杉矶县癌症监测项目数据库。1990年至1998年间，共诊断出43411例乳腺癌病例，其中29666例有关于外科医生、医院和分期信息的完整数据。患者根据外科医生和医院专科化情况，以及年龄、种族、分期、手术方式、外科医生和医院的病例数量进行分层。对生存情况及其对这些因素的依赖性进行了分析。
年龄、种族、社会经济地位、肿瘤大小、淋巴结状态、疾病范围、外科医生专科化、外科医生病例数量和医院病例数量均与乳腺癌诊断后的5年生存率相关。在专科中心接受治疗对生存情况没有影响。多变量分析表明，外科医生类型是生存情况的独立预测因素（相对风险为0.77），医院和外科医生的病例数量也是如此。
由外科肿瘤学家进行治疗可使5年死亡风险降低33%。外科专科化的影响不能完全归因于病例数量的影响。
