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由妇科肿瘤专科顾问医生进行手术可提高卵巢癌患者的生存率。

Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinoma.

作者信息

Engelen Mirjam J A, Kos Henrike E, Willemse Pax H B, Aalders Jan G, de Vries Elisabeth G E, Schaapveld Michael, Otter Renee, van der Zee Ate G J

机构信息

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands.

出版信息

Cancer. 2006 Feb 1;106(3):589-98. doi: 10.1002/cncr.21616.

DOI:10.1002/cncr.21616

PMID:16369985

Abstract

BACKGROUND

Consultant gynecologic oncologists from the regional Comprehensive Cancer Center assisted community gynecologists in the surgical treatment of patients with ovarian carcinoma when they were invited. For this report, the authors evaluated the effects of primary surgery by a gynecologic oncologist on treatment outcome.

METHODS

The hospital files from 680 patients with epithelial ovarian carcinoma who were diagnosed between 1994 and 1997 in the northern part of the Netherlands were abstracted. Treatment results were analyzed according to the operating physician's education by using survival curves and univariate and multivariate Cox regression analyses.

RESULTS

Primary surgery was performed on 184 patients by gynecologic oncologists, and on 328 patients by general gynecologists. Gynecologic oncologists followed surgical guidelines more strictly compared with general gynecologists (patients with International Federation of Gynecology and Obstetrics [FIGO] Stage I-II disease, 55% vs. 33% [P=0.01]; patients with FIGO Stage III disease, 60% vs. 40% [P=0.003]) and more often removed all macroscopic tumor in patients with FIGO Stage III disease (24% vs. 12%; P=0.02). When patients were stratified according to FIGO stage, the 5-year overall survival rate was 86% versus 70% (P=0.03) for patients with Stage I-II disease and 21% versus 13% (P=0.02) for patients with Stage III-IV disease who underwent surgery by gynecologic oncologists and general gynecologists, respectively. The hazards ratio for patients who underwent surgery by gynecologic oncologists was 0.79 (95% confidence interval [95%CI], 0.61-1.03; adjusted for patient age, disease stage, type of hospital, and chemotherapy); when patients age 75 years and older were excluded, the hazards ratio fell to 0.71 (95% CI, 0.54-0.94) in multivariate analysis.

CONCLUSIONS

The surgical treatment of patients with ovarian carcinoma by gynecologic oncologists occurred more often according to surgical guidelines, tumor removal more often was complete, and survival was improved.

摘要

背景

地区综合癌症中心的妇科肿瘤学顾问在受到邀请时会协助社区妇科医生对卵巢癌患者进行手术治疗。在本报告中，作者评估了由妇科肿瘤学医生进行初次手术对治疗结果的影响。

方法

提取了1994年至1997年在荷兰北部被诊断为上皮性卵巢癌的680例患者的医院档案。通过生存曲线以及单因素和多因素Cox回归分析，根据手术医生的专业背景对治疗结果进行分析。

结果

184例患者由妇科肿瘤学医生进行初次手术，328例患者由普通妇科医生进行手术。与普通妇科医生相比，妇科肿瘤学医生更严格地遵循手术指南（国际妇产科联盟[FIGO] I-II期疾病患者，分别为55%对33%[P = 0.01]；FIGO III期疾病患者，分别为60%对40%[P = 0.003]），并且在FIGO III期疾病患者中更常完全切除所有肉眼可见肿瘤（分别为24%对12%；P = 0.02）。当根据FIGO分期对患者进行分层时，I-II期疾病患者中，由妇科肿瘤学医生和普通妇科医生进行手术的患者5年总生存率分别为86%和70%（P = 0.03），III-IV期疾病患者分别为21%和13%（P = 0.02）。接受妇科肿瘤学医生手术的患者的风险比为0.79（95%置信区间[95%CI]，0.61 - 1.03；根据患者年龄、疾病分期、医院类型和化疗进行调整）；排除75岁及以上患者后，多因素分析中风险比降至0.71（95%CI，0.54 - 0.94）。