Department of Obstetrics and Gynaecology, Affiliated with University Malaya Cancer Research Institute, Faculty of Medicine, University Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
Gynecol Oncol. 2012 Aug;126(2):286-90. doi: 10.1016/j.ygyno.2012.04.012. Epub 2012 Apr 13.
Gynaecological cancers are the second most common cancers among women. It has been suggested that centralised care improves outcomes but consensus is lacking. This systematic review assesses the effectiveness of centralisation of care for patients with gynaecological cancer, in particular, survival advantage.
A comprehensive search of the Cochrane Gynaecological Cancer Group Trials Register, CENTRAL (The Cochrane Library, Issue 4, 2010), MEDLINE, and EMBASE up to November 2010 was conducted. Registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies were also searched. Randomised controlled trials (RCTs), quasi-RCTs, controlled before-and-after studies, interrupted time series studies, and observational studies were included and multivariable analysis to adjust for baseline case mix were used.
Five retrospective observational studies met the inclusion criteria. Meta-analysis of three studies assessing over 9000 women suggested that institutions with gynaecologic oncologists on site may prolong survival in women with ovarian cancer, compared to community or general hospitals: hazard ratio (HR) of death was 0.90 (95% confidence interval (CI) 0.82 to 0.99). Similarly, another meta-analysis of three studies assessing over 50,000 women, found that teaching centres or regional cancer centres may prolong survival in women with any gynaecological cancer compared to community or general hospitals (HR 0.91; 95% CI 0.84 to 0.99). The largest of these studies included all gynaecological malignancies and assessed 48,981 women, so the findings extend beyond ovarian cancer. One study compared community hospitals with semi-specialised gynaecologists versus general hospitals and reported non-significantly better disease-specific survival in women with ovarian cancer (HR 0.89; 95% CI 0.78 to 1.01). The findings of included studies were highly consistent.
The meta-analysis provides evidence to suggest that women with gynaecological cancer who received treatment in specialised centres had longer survival than those managed elsewhere.
妇科癌症是女性中第二常见的癌症。有研究表明集中护理可以改善治疗效果，但目前尚未达成共识。本系统评价评估了妇科癌症患者集中护理的有效性，特别是生存优势。
对 Cochrane 妇科癌症组试验注册中心（Cochrane 图书馆，2010 年第 4 期）、CENTRAL（CENTRAL，The Cochrane Library，2010 年第 4 期）、MEDLINE 和 EMBASE 进行了全面检索，检索时间截至 2010 年 11 月。还检索了临床试验登记处、科学会议摘要和纳入研究的参考文献列表。纳入了随机对照试验（RCT）、准 RCT、对照前后研究、中断时间序列研究和观察性研究，并使用多变量分析来调整基线病例组合。
有 5 项回顾性观察性研究符合纳入标准。对 3 项评估超过 9000 名女性的研究进行荟萃分析表明，有妇科肿瘤学家的机构可能会延长卵巢癌女性的生存时间，与社区或综合医院相比：死亡风险比（HR）为 0.90（95%置信区间（CI）为 0.82 至 0.99）。同样，对 3 项评估超过 50000 名女性的研究进行的另一个荟萃分析发现，与社区或综合医院相比，教学中心或区域癌症中心可能会延长所有妇科癌症女性的生存时间（HR 0.91；95%CI 0.84 至 0.99）。其中最大的一项研究纳入了所有妇科恶性肿瘤，评估了 48981 名女性，因此这些发现超出了卵巢癌的范围。有一项研究比较了社区医院与半专科妇科医生与综合医院，报告卵巢癌女性的疾病特异性生存率有非显著改善（HR 0.89；95%CI 0.78 至 1.01）。纳入研究的结果高度一致。
荟萃分析提供的证据表明，在专门中心接受治疗的妇科癌症女性的生存时间长于在其他地方接受治疗的女性。
