Vernooij Flora, Heintz A Peter M, Coebergh Jan-Willem, Massuger Leon F A G, Witteveen Petronella O, van der Graaf Yolanda
Department of Gynecological Surgery and Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Gynecol Oncol. 2009 Mar;112(3):455-61. doi: 10.1016/j.ygyno.2008.11.011. Epub 2009 Jan 12.
We investigated the influence of hospital and gynecologist level of specialization and volume on surgical results and on survival of ovarian cancer patients.
Data were collected from 1077 ovarian cancer patients treated from 1996 to 2003 in a random sample of 18 Dutch hospitals. Hospitals and gynecologists were classified according to specialization (general, semi-specialized or specialized) and by volume (<or=6, 7-12, or >12 cases/year). Outcomes were percentage of adequately staged and optimally debulked patients and length of overall survival. Data were analyzed using multivariable logistic regression (surgical results) and Cox regression (survival).
The level of specialization and the volume of hospitals and of gynecologists were strongly related to the proportion of adequately staged patients (adjusted odds ratio (OR) specialized hospitals 3.9 (95% confidence interval (CI) 2.0-7.6); specialized gynecologists 9.5 (95% CI 4.7-19)). Patients with stage III disease had a higher chance of optimal debulking when treated in specialized hospitals (adjusted OR 1.7 (95% CI 1.1-2.7)) or by high volume gynecologists (adjusted OR 2.8 (95% CI 1.4-5.7)). Overall survival was best in patients treated in specialized hospitals and by high-volume gynecologists.
The specialization level of hospitals and the surgical volume of gynecologists positively influence outcomes of surgery and survival. Concentration of ovarian cancer care thus seems warranted.
我们研究了医院及妇科医生的专业水平和手术量对卵巢癌患者手术结果及生存率的影响。
收集了1996年至2003年期间在荷兰18家医院的随机样本中接受治疗的1077例卵巢癌患者的数据。医院和妇科医生根据专业程度（普通、半专科或专科）以及手术量（每年≤6例、7 - 12例或>12例）进行分类。观察指标为分期恰当和减瘤理想的患者百分比以及总生存时间。数据采用多变量逻辑回归（手术结果）和Cox回归（生存情况）进行分析。
医院和妇科医生的专业水平及手术量与分期恰当的患者比例密切相关（调整后的优势比（OR）：专科医院为3.9（95%置信区间（CI）2.0 - 7.6）；专科妇科医生为9.5（95% CI 4.7 - 19））。III期疾病患者在专科医院接受治疗（调整后的OR 1.7（95% CI 1.1 - 2.7））或由手术量大的妇科医生治疗（调整后的OR 2.8（95% CI 1.4 - 5.7））时，达到理想减瘤的机会更高。在专科医院接受治疗且由手术量大的妇科医生治疗的患者总生存情况最佳。
医院的专业水平和妇科医生的手术量对手术结果和生存率有积极影响。因此，卵巢癌护理的集中化似乎是有必要的。
