du Bois Andreas, Rochon Justine, Pfisterer Jacobus, Hoskins William J
Department of Gynecology and Gynecologic Oncology, Dr. Horst Schmidt Klinik (HSK), Ludwig-Erhard-Str. 100, D-65199 Wiesbaden, Germany.
Gynecol Oncol. 2009 Feb;112(2):422-36. doi: 10.1016/j.ygyno.2008.09.036. Epub 2008 Nov 6.
Ovarian cancer outcome varies among different institutions, regions, and countries. This systematic review summarizes the available data evaluating the impact of different physician and hospital characteristics on outcome in ovarian cancer patients.
A MEDLINE database search for pertinent publications was conducted and reference lists of each relevant article were screened. Experts in the field were contacted. Selected studies assessed the relationship between physician and/or hospital specialty or volume and at least one of the outcomes of interest. The primary outcome was survival. Additional parameters included surgical outcome (debulking), completeness of staging, and quality of chemotherapy. The authors independently reviewed each article and applied the inclusion/exclusion criteria. The quality of each study was assessed by focusing on strategies to control for important prognostic factors.
Forty-four articles met inclusion criteria. Discipline and sub-specialization of the primary treating physician were identified as the most important variable associated with superior outcome. Evidence showing a beneficial impact of institutional factors was weaker, but followed the same trend. Hospital volume was hardly related to any outcome parameter.
The limited evidence available showed considerable heterogeneity and has to be interpreted cautiously. Better utilization of knowledge about institutional factors and well-established board certifications may improve outcome in ovarian cancer. Patients and primary-care physicians should select gynecologic oncologists for primary treatment in countries with established sub-specialty training. Policymakers, insurance companies, and lay organizations should support development of respective programs.
卵巢癌的治疗结果在不同机构、地区和国家之间存在差异。本系统评价总结了现有数据，评估不同医生和医院特征对卵巢癌患者治疗结果的影响。
对MEDLINE数据库进行检索以查找相关出版物，并筛选每篇相关文章的参考文献列表。联系了该领域的专家。入选研究评估了医生和/或医院专科或工作量与至少一项感兴趣的结果之间的关系。主要结果是生存率。其他参数包括手术结果（肿瘤细胞减灭术）、分期的完整性和化疗质量。作者独立审查每篇文章并应用纳入/排除标准。通过关注控制重要预后因素的策略来评估每项研究的质量。
44篇文章符合纳入标准。确定主要治疗医生的学科和亚专业是与较好治疗结果相关的最重要变量。显示机构因素有有益影响的证据较弱，但趋势相同。医院工作量与任何结果参数几乎没有关系。
现有有限证据显示出相当大的异质性，必须谨慎解读。更好地利用关于机构因素的知识和完善的委员会认证可能会改善卵巢癌的治疗结果。在有成熟亚专业培训的国家，患者和初级保健医生应选择妇科肿瘤学家进行初始治疗。政策制定者、保险公司和非专业组织应支持相应项目的开展。
