Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-6904, USA.
Gynecol Oncol. 2010 Apr;117(1):18-22. doi: 10.1016/j.ygyno.2009.12.033. Epub 2010 Jan 27.
One of the cornerstones of ovarian cancer therapy is cytoreductive surgery, which can be performed by surgeons with different specialty training. We examined whether surgeon specialty impacts quality of life (as proxied by presence of ostomy) and overall survival for women with advanced ovarian cancer.
Stage IIIC/IV ovarian cancer patients were identified using 4 state cancer registries: California, Washington, New York, and Florida and linked records to the corresponding inpatient-hospital discharge file, AMA Masterfile, and 2000 U.S. Census SF4 File. Predictors of receipt of care by a general surgeon and creation of fecal ostomy were analyzed. Multivariate modeling was performed to assess the association of hospital volume (low volume (LV) [0-4 cases], middle volume (MV) [5-9], high volume (HV) [10-19], and very high volume (VHV) [20+]) and surgeon specialty training (gynecologic oncologists/gynecologists, general surgeons, and other specialty) on survival.
We identified 31,897 Stage IIIC/IV patients; mean age was 64 years. Treatment of patients by a general surgeon was predicted by LV, rural patient residence, poverty, and high level of comorbidity. Patients had lower hazard of death when treated in higher volume hospitals as compared to LV [VHV hazard ratio (HR)=0.79, P<.0001; HV HR=0.89, P<0.001]. Patients treated by a general surgeon had higher likelihood of an ostomy (OR=4.46, P<.0001) and hazard of death (HR=1.63, P<.0001) compared to gynecologic oncologist/gynecologist.
Advanced stage ovarian cancer patients have better survival when treated by gynecologic oncology/gynecology trained surgeons. Data suggest that referral to these specialists may optimize surgical debulking and minimize the creation of a fecal ostomy.
卵巢癌治疗的基石之一是细胞减灭术，可以由具有不同专业培训的外科医生进行。我们研究了外科医生的专业是否会影响晚期卵巢癌患者的生活质量（表现为造口术的存在）和总体生存率。
使用加利福尼亚州、华盛顿州、纽约州和佛罗里达州的 4 个州癌症登记处确定 IIIC/IV 期卵巢癌患者，并将记录与相应的住院患者出院档案、美国医学协会主文件和 2000 年美国人口普查 SF4 文件相关联。分析了接受普通外科医生治疗和创建粪便造口术的预测因素。进行多变量建模以评估医院容量（低容量（LV）[0-4 例]、中容量（MV）[5-9 例]、高容量（HV）[10-19 例]和超高容量（VHV）[20+例]）和外科医生专业培训（妇科肿瘤学家/妇科医生、普通外科医生和其他专业）对生存率的影响。
我们确定了 31897 例 IIIC/IV 期患者；平均年龄为 64 岁。LV、农村患者居住地、贫困和高合并症水平预测了普通外科医生的治疗。与 LV 相比，在更高容量的医院接受治疗的患者死亡风险更低[VHV 危险比（HR）=0.79，P<.0001；HV HR=0.89，P<.001]。与妇科肿瘤学家/妇科医生相比，接受普通外科医生治疗的患者造口术（OR=4.46，P<.0001）和死亡风险（HR=1.63，P<.0001）更高。
接受妇科肿瘤学/妇科医生培训的外科医生治疗晚期卵巢癌患者的生存率更高。数据表明，将这些专家转诊可能会优化手术减瘤术，并最大限度地减少粪便造口术的创建。
