Vernooij Flora, Heintz Peter, Witteveen Els, van der Graaf Yolanda
Department of Gynecologic Surgery and Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Gynecol Oncol. 2007 Jun;105(3):801-12. doi: 10.1016/j.ygyno.2007.02.030. Epub 2007 Apr 12.
There is much debate on the effect of specialized care for ovarian cancer patients. In this review we present an overview and summary of the recent literature on this subject.
The Pubmed database was searched for studies on the relationship between care setting (type of gynecologist or hospital) and care outcomes which were published between January 1991 and November 2006. Studies were included if they were of sufficient quality and included patients treated from 1990 onwards.
Nineteen articles were retrieved. There were no randomized controlled trials on this subject. Staging and debulking were consistently found to be performed more adequately by gynecologic oncologists (pooled relative risk of optimal debulking by a gynecologic oncologist to <2 cm residual disease 1.4 (95%CI 1.2-1.5) and to no macroscopic disease 2.3 (95%CI 1.5-3.5)) and in specialized hospitals (odds ratios for optimal debulking varied between 1.9 and 6.0). There were no differences in postoperative complication rates between different providers. Chemotherapy was given 1-15% more often in specialized settings. Differences in chemotherapy did not lead to differences in survival of patients treated by gynecologic oncologists, but did influence the effect of hospital on survival. Long-term survival was better after treatment in a specialized hospital. Surgery by a gynecologic oncologist resulted in longer survival in subgroups of patients, leading to a 5- to 8-month median survival benefit for patients with advanced stage disease.
The outcome of ovarian cancer is better when treatment is provided by a gynecologic oncologist or in a specialized hospital.
关于卵巢癌患者专科护理的效果存在诸多争议。在本综述中,我们呈现了关于该主题的近期文献综述与总结。
检索了1991年1月至2006年11月期间发表的关于护理环境(妇科医生类型或医院类型)与护理结局之间关系的研究。若研究质量足够且纳入了1990年起接受治疗的患者,则纳入本研究。
检索到19篇文章。关于该主题没有随机对照试验。一直发现妇科肿瘤学家进行分期和肿瘤细胞减灭术更为充分(妇科肿瘤学家进行达到残留病灶<2cm的最佳肿瘤细胞减灭术的合并相对风险为1.4(95%置信区间1.2 - 1.5),达到无肉眼可见病灶的合并相对风险为2.3(95%置信区间1.5 - 3.5)),且在专科医院中也是如此(最佳肿瘤细胞减灭术的优势比在1.9至6.0之间)。不同医疗服务提供者之间术后并发症发生率没有差异。在专科环境中进行化疗的频率要高出1%至15%。化疗的差异并未导致妇科肿瘤学家治疗的患者生存率出现差异,但确实影响了医院对生存率的作用。在专科医院接受治疗后的长期生存率更高。妇科肿瘤学家进行的手术使患者亚组的生存期延长,晚期疾病患者的中位生存期获益5至8个月。
由妇科肿瘤学家或在专科医院进行治疗时,卵巢癌的治疗效果更佳。