Mayo Clinic, Rochester, Minnesota 55902, USA.
Cancer. 2012 Apr 1;118(7):1827-37. doi: 10.1002/cncr.26474. Epub 2011 Aug 26.
The impact of physicians' disease-specific expertise on patient outcome is unknown. Although previous studies suggest a survival advantage for cancer patients cared for at high-volume centers, these observations may simply reflect referral bias or better access to advanced technologies, clinical trials, and multidisciplinary support at large centers.
We evaluated time to first treatment (TTFT) and overall survival (OS) of patients with newly diagnosed chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) at a single academic center based on whether they were cared for by a hematologist/oncologist who subspecializes in CLL (CLL hematologist) or a hematologist/oncologist with expertise in other areas (non-CLL hematologist).
Among 1309 newly diagnosed patients with CLL cared for between 1999 and 2009, 773(59%) were cared for by CLL hematologists and 536 were cared for by non-CLL hematologists. Among early-stage patients (Rai 0-I), median TTFT (9.2 vs 6.1 years; P < .001) and OS (10.5 years vs 8.8 years; P < .001) were longer for patients cared for by CLL hematologists. For all patients, OS was superior for patients cared for by CLL hematologists (10.5 years vs 8.4 years; P = .001). Physician's disease-specific expertise remained an independent predictor of OS after adjusting for age, sex, stage, and lymphocyte count at diagnosis. Patients seen by a CLL hematologist were also more likely to participate in clinical trials (48% vs 16%; P < .001).
Physician disease-specific expertise appears to influence outcome in patients with CLL. To the greatest extent possible, patients should be cared for by a hematologist/oncologist expert in the care of their specific malignancy. When not possible, practice guidelines developed by disease-specific experts should be followed.
医生的疾病专业知识对患者预后的影响尚不清楚。尽管先前的研究表明，癌症患者在高容量中心接受治疗具有生存优势，但这些观察结果可能仅仅反映了转诊偏见或在大型中心更容易获得先进技术、临床试验和多学科支持。
我们根据患者是否由专门研究 CLL 的血液科肿瘤学家（CLL 血液学家）或在其他领域有专长的血液科肿瘤学家（非 CLL 血液学家）治疗，评估了单中心新诊断的慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL）患者的首次治疗时间（TTFT）和总生存期（OS）。
在 1999 年至 2009 年间接受治疗的 1309 例新诊断 CLL 患者中，773 例（59%）由 CLL 血液学家治疗，536 例由非 CLL 血液学家治疗。在早期患者（Rai 0-I）中，由 CLL 血液学家治疗的患者的中位 TTFT（9.2 年 vs 6.1 年；P<.001）和 OS（10.5 年 vs 8.8 年；P<.001）均较长。对于所有患者，由 CLL 血液学家治疗的患者的 OS 更高（10.5 年 vs 8.4 年；P=.001）。在校正年龄、性别、分期和诊断时的淋巴细胞计数后，医生的疾病专业知识仍然是 OS 的独立预测因素。由 CLL 血液学家治疗的患者也更有可能参加临床试验（48% vs 16%；P<.001）。
医生的疾病专业知识似乎会影响 CLL 患者的预后。在尽可能的情况下，患者应接受专门治疗其特定恶性肿瘤的血液科肿瘤学家的治疗。在无法做到这一点的情况下，应遵循由疾病专家制定的实践指南。
