Addenbrookes Hospital, Cambridge, UK.
BJOG. 2012 Jan;119(2):160-5. doi: 10.1111/j.1471-0528.2011.02961.x. Epub 2011 Apr 12.
Our hypothesis is that the adoption of Department of Health (DH) guidance has led to an improvement in outcome in gynaecological cancer survival.
In 1999 the DH in England introduced the Improving Outcomes in Gynaecological Cancer guidance, advising case management by multidisciplinary teams with surgical concentration in specialist hospitals. This guidance was rapidly adopted in the East of England, with a population of 2.5 million.
The population of the Anglia Cancer Network was approximately 2.3 million.
From 1996 to 2003, details of 3406 cases of gynaecological cancer were identified in the Anglia region of England. Survival analysis was performed by Cox proportional hazards regression, relative to cases diagnosed in 1996.
Primary endpoint was survival.
The survival rates for cases diagnosed between 1996 and 1999 were broadly the same across the time period, with a marked improvement taking place in 2000, and continuing to 2003 (HR 0.71, 95% CI 0.64-0.79, comparing 2000-03 with 1996-99 diagnoses), for all gynaecological sites combined. Adjustment for treatments or method of case follow-up did not attenuate these improvements. There was a concurrent change towards major surgery being performed in specialist centres from 2000.
The adoption of the 1999 guidance on gynaecological cancer, which included multidisciplinary case management and centralisation of surgery, resulted in a marked step-change improvement in survival of gynaecological cancer in an area of eastern England in 2000.
我们的假设是，采用卫生部（DH）的指导意见导致妇科癌症患者的生存结局得到改善。
1999 年，英国卫生部（DH）在英格兰推出了改善妇科癌症治疗效果的指导意见，建议通过多学科团队对病例进行管理，并将手术集中在专科医院进行。该指导意见在拥有 250 万人口的英格兰东部迅速得到采用。
东安格利亚癌症网络的人口约为 230 万。
1996 年至 2003 年，在英格兰东安格利亚地区确定了 3406 例妇科癌症病例。采用 Cox 比例风险回归法对生存情况进行分析，以 1996 年确诊的病例为参照。
主要终点是生存。
1996 年至 1999 年期间确诊的病例的生存率在整个时间段内大致相同，2000 年开始出现显著改善，并持续到 2003 年（2000-03 年与 1996-99 年诊断病例相比，HR 为 0.71，95%CI 为 0.64-0.79），所有妇科部位的病例均如此。对治疗方法或病例随访方法进行调整并不能减弱这些改善。2000 年开始，主要手术也同时向专科医院转移。
2000 年，在英国东部地区，对妇科癌症的治疗指南（包括多学科病例管理和手术集中）的采用，导致妇科癌症患者的生存率发生了显著的阶段性改善。
