Roland P Y, Kelly F J, Kulwicki C Y, Blitzer P, Curcio M, Orr J W
Florida Gynecologic Oncology, Fort Myers, FL 33901, USA.
Gynecol Oncol. 2004 Apr;93(1):125-30. doi: 10.1016/j.ygyno.2003.12.018.
Compare important aspects of initial endometrial cancer treatment in women with or without primary management by a gynecologic oncologist (GYO).
A retrospective pattern of care study was conducted using tumor registry data from a community-based health care system. Surgically treated endometrial cancer cases were reviewed with respect to histology, training of surgeon(s), procedures, TNM staging, and prescription of adjuvant radiation.
Two hundred and seven consecutive cases completed between January 1998 and December 2000 were analyzed. Overall surgical stage was 78.4% stage I, 6.9% stage II, and 14.7% stage III-IV. Gynecologic oncologists (GYOs) provided care in 101 (48.8%) and gynecologists (GYNs) in 104 cases (50.2%). General surgeons (GSs) assisted gynecologists in 36.5% of cases. GYOs (94.0%) completed TNM staging two times more frequently (P < 0.05) than GYNs (45.2%). The incidence of lymph node assessment by GYOs was 83.0% (average number of nodes, 19.5) and GYNs 26.0% (average number of nodes, 7.7). Advanced disease (stage III-IV) was more frequently (P < 0.05) managed by GYOs (23.0%) than GYNs (6.7%). Radiation (RT) was prescribed to 36 (17.4%) patients. When evaluating TI and TII tumors at risk for extrauterine spread (G2-G3 or myometrial invasion), GYOs completed surgical staging more frequently than GYNs (95.7% vs. 18.8%, P < 0.05). GYO patients received radiation (six patients: 8.6%) less frequently than GYN patients (8.6% vs. 21.7%). No patient managed by GYOs with T1 N0 disease received RT. Eighteen percent of patients managed by GYNs with T1 N0 or T1 NX received RT.
Gynecologic oncologists are more likely to evaluate and manage those with advanced endometrial cancer. Women with endometrial cancer managed by GYOs are more likely to receive comprehensive TNM surgical staging. The employment of complete TNM staging by GYOs reduced the use of RT in those with T1 N0 or Nx disease by 100%. These results suggest that primary management by gynecologic oncologists results in an efficient use of health care resources and minimized the potential morbidity associated with adjuvant radiation.
比较由妇科肿瘤学家（GYO）进行初始管理或未进行初始管理的子宫内膜癌女性患者在初始治疗方面的重要情况。
利用来自一个社区医疗保健系统的肿瘤登记数据进行了一项回顾性医疗模式研究。对接受手术治疗的子宫内膜癌病例的组织学、外科医生培训、手术、TNM分期及辅助放疗处方进行了审查。
分析了1998年1月至2000年12月期间连续的207例病例。总体手术分期为：I期占78.4%，II期占6.9%，III - IV期占14.7%。101例（48.8%）由妇科肿瘤学家（GYO）提供治疗，104例（50.2%）由妇科医生（GYN）提供治疗。普通外科医生（GS）在36.5%的病例中协助妇科医生。妇科肿瘤学家（GYO）完成TNM分期的频率（94.0%）比妇科医生（GYN）（45.2%）高出两倍多（P < 0.05）。妇科肿瘤学家进行淋巴结评估的发生率为83.0%（平均淋巴结数量为19.5个），妇科医生为26.0%（平均淋巴结数量为7.7个）。与妇科医生（6.7%）相比，妇科肿瘤学家（GYO）对晚期疾病（III - IV期）的治疗更为频繁（P < 0.05）（23.0%）。36例（17.4%）患者接受了放疗。在评估有子宫外扩散风险（G2 - G3或肌层浸润）的I期和II期肿瘤时，妇科肿瘤学家比妇科医生更频繁地完成手术分期（95.7%对18.8%，P < 0.05）。妇科肿瘤学家治疗的患者接受放疗的频率（6例患者：8.6%）低于妇科医生治疗患者（8.6%对21.7%）。由妇科肿瘤学家治疗的T1 N0疾病患者均未接受放疗。由妇科医生治疗的T1 N0或T1 NX患者中有18%接受了放疗。
妇科肿瘤学家更有可能对晚期子宫内膜癌患者进行评估和治疗。由妇科肿瘤学家治疗的子宫内膜癌女性更有可能接受全面的TNM手术分期。妇科肿瘤学家采用完整的TNM分期使T1 N0或Nx疾病患者的放疗使用率降低了100%。这些结果表明由妇科肿瘤学家进行初始管理可有效利用医疗保健资源，并将与辅助放疗相关的潜在发病率降至最低。
