外科肿瘤学家与普通外科医生之间乳腺癌治疗结局改善的机制。

Mechanisms of improved outcomes for breast cancer between surgical oncologists and general surgeons.

机构信息

OU Breast Institute, University of Oklahoma, Oklahoma City, OK, USA.

出版信息

Ann Surg Oncol. 2011 Nov;18(12):3248-51. doi: 10.1245/s10434-011-1771-7. Epub 2011 May 17.

DOI:10.1245/s10434-011-1771-7

PMID:21584834

Abstract

BACKGROUND

Prior multi-institutional studies have reported a survival benefit of breast cancer treatment by surgical oncologists (SO) over general surgeons (GS).

METHODS

Retrospective review tumor registry data of all breast cancer patients receiving primary treatment at a single institution from January 1, 1995, to December 31, 2008.

RESULTS

During the time period, there were 2192 patients who received primary breast cancer treatment at this institution. The mean age was 57 years and the mean follow-up was >55 months. Stage distribution was similar between GS and SO. Overall survival (SO 83.8% vs. GS 75.6%) and disease-free survival (SO 80.7% vs. GS 72.0%) was highly statistically significant (P<0.0001). For stages 1, 2a, 2b, 3a, and 3b there were statistically significant (P<0.05) differences for overall and disease-free survival. Overall, the use of breast conservation was more likely by SO-52.6 vs. 38.3% all stages and 65.8 vs. 54.0% for stage 0-2. The compliance with all systemic therapies (chemotherapy and hormone therapy) was more likely if being treated by SO-77.3 vs. 68.5% (P<0.02). The use of radiotherapy for breast conservation and in stage 3 mastectomy patients was higher for SO (P<0.001). Participation in clinical trials was far higher for SO patients-56.2 vs. GS 7.0% (P<0.001).

CONCLUSIONS

The value added by having primary breast cancer treatment by a SO seems to arise from the more successful completion of multidisciplinary care in a timely fashion and higher rates of clinical trial involvement.

摘要

背景

先前的多机构研究报告称，乳腺癌患者接受外科肿瘤学家（SO）治疗比接受普通外科医生（GS）治疗的生存率更高。

方法

回顾性分析单机构 1995 年 1 月 1 日至 2008 年 12 月 31 日期间所有接受原发性乳腺癌治疗的患者的肿瘤登记数据。

结果

在此期间，有 2192 名患者在该机构接受了原发性乳腺癌治疗。平均年龄为 57 岁，平均随访时间超过 55 个月。GS 和 SO 组的分期分布相似。总体生存率（SO 为 83.8%，GS 为 75.6%）和无病生存率（SO 为 80.7%，GS 为 72.0%）差异具有统计学意义（P<0.0001）。对于 1 期、2a 期、2b 期、3a 期和 3b 期，总体生存率和无病生存率均存在统计学差异（P<0.05）。总体而言，SO 组保乳术的使用率更高（SO 组为 52.6%，GS 组为 38.3%，所有分期；SO 组为 65.8%，GS 组为 54.0%，0-2 期）。如果由 SO 治疗，患者接受全身治疗（化疗和激素治疗）的依从性更高（SO 组为 77.3%，GS 组为 68.5%，P<0.02）。SO 组用于保乳术和 3 期乳房切除术患者的放疗使用率更高（P<0.001）。SO 患者参与临床试验的比例远高于 GS 患者（SO 组为 56.2%，GS 组为 7.0%，P<0.001）。