Silber Jeffrey H, Rosenbaum Paul R, Polsky Daniel, Ross Richard N, Even-Shoshan Orit, Schwartz J Sanford, Armstrong Katrina A, Randall Thomas C
The Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
J Clin Oncol. 2007 Apr 1;25(10):1169-75. doi: 10.1200/JCO.2006.08.2933.
Chemotherapy for ovarian cancer is usually administered by medical oncologists (MOs) or gynecologic oncologists (GOs). GOs perform a broad spectrum of surgical and medical activities while managing a limited number of diseases; MOs specialize in the administration of chemotherapy but manage a broad array of diseases. We asked whether survival, treatment, and toxicity differed according to the type of specialist providing the chemotherapy after surgery.
Using Surveillance, Epidemiology, and End Results (SEER)--Medicare data for patients 65 years old from 1991 through 2001 from eight SEER sites, we identified 344 patients with ovarian cancer who were treated with chemotherapy by a GO after surgery. Using optimal matching and propensity scores based on 36 characteristics, we matched these patients to 344 similar patients who were operated on and staged by the same type of surgeon but who received chemotherapy from an MO.
MOs administered chemotherapy over more weeks than did the GOs (16.5 v 12.1 weeks, respectively; P < .0023), and MO patients had substantially more weeks that included chemotherapy-associated adverse events than GO patients (16.2 v 8.9 weeks, respectively; P < .0001). However, there was no difference in 5-year survival rate between the GO and MO groups (35% v 34%, respectively; P = .45).
GO- and MO-treated patients who were closely matched on prognostic characteristics experienced very different rates of chemotherapy-associated adverse events and very different chemotherapy treatment styles by specialty type; however, their survival was virtually identical.
卵巢癌化疗通常由医学肿瘤学家（MOs）或妇科肿瘤学家（GOs）实施。GOs在管理有限数量疾病的同时开展广泛的外科和医疗活动；MOs则专长于化疗给药，但管理的疾病种类繁多。我们探讨了术后化疗由不同专科医生提供时，患者的生存率、治疗情况及毒性反应是否存在差异。
利用监测、流行病学和最终结果（SEER）——1991年至2001年来自8个SEER站点的65岁患者的医疗保险数据，我们确定了344例卵巢癌患者，这些患者术后接受了GOs的化疗。基于36项特征，通过最佳匹配和倾向评分，我们将这些患者与344例相似患者进行匹配，这些相似患者由同类型外科医生进行手术和分期，但接受MOs的化疗。
MOs化疗的周数比GOs多（分别为16.5周和12.1周；P <.0023），且MO组患者出现化疗相关不良事件的周数显著多于GO组患者（分别为16.2周和8.9周；P <.0001）。然而 GO组和MO组的5年生存率无差异（分别为35%和34%；P = 0.45）。
在预后特征上紧密匹配的接受GOs和MOs治疗患者，化疗相关不良事件发生率和专科化疗治疗方式差异很大；然而，他们的生存率几乎相同。
