University of Alabama at Birmingham, Division of Gynecologic Oncology, USA.
University of Alabama at Birmingham, Department of Obstetrics and Gynecology, USA.
Gynecol Oncol. 2014 May;133(2):142-6. doi: 10.1016/j.ygyno.2014.02.006. Epub 2014 Feb 8.
The National Comprehensive Cancer Network (NCCN) has established guidelines for treating epithelial ovarian cancer (EOC) which includes cytoreductive surgery and platinum and taxane-based chemotherapy (CT). The objective of this study was to determine the reasons for failure to deliver NCCN-adherent care at an NCCN cancer center serving a diverse racial and socioeconomic population.
Medical records of women with EOC diagnosed between 2004 and 2009 were reviewed for demographic, clinical, tumor, treatment, and survival data. Independent reviewers determined if their treatment met criteria for being NCCN-adherent. Progression-free survival (PFS) and overall survival (OS) were calculated with Kaplan-Meier estimates and compared with the log-rank test.
367 patients were identified. 79 (21.5%) did not receive NCCN-adherent care. Non-adherent CT in 75 patients was the most common reason for failure to receive NCCN-adherent care. 39 patients did not complete CT due to treatment toxicities or disease progression. 12 patients received single agent CT only and 4 received no CT due to comorbidities. 2 patients declined CT. 18 patients died in the postoperative period without receiving CT. 8 patients did not undergo cytoreduction due to disease progression or comorbidities. PFS and OS were improved in the NCCN-adherent cohort (PFS: 5.7 vs. 18.3 months, p<.005) (OS: 11.4 vs. 49.5 months, p<.005).
The vast majority of patients at an NCCN cancer center received NCCN-adherent treatment. Reasons for failure to receive NCCN-adherent care were variable, but most did not receive chemotherapy in accordance with guidelines due to comorbidities or disease progression.
美国国家综合癌症网络（NCCN）制定了上皮性卵巢癌（EOC）的治疗指南，包括细胞减灭术和基于铂类和紫杉烷的化疗（CT）。本研究的目的是确定在为不同种族和社会经济人群服务的 NCCN 癌症中心未能提供符合 NCCN 标准的治疗的原因。
对 2004 年至 2009 年间诊断为 EOC 的女性的病历进行了回顾性分析，以获取人口统计学、临床、肿瘤、治疗和生存数据。独立评审员确定其治疗是否符合 NCCN 标准。无进展生存期（PFS）和总生存期（OS）用 Kaplan-Meier 估计值计算，并与对数秩检验进行比较。
共确定了 367 例患者。79 例（21.5%）未接受 NCCN 标准的治疗。75 例患者因未接受 NCCN 标准的 CT 治疗是未接受 NCCN 标准治疗的最常见原因。39 例患者因治疗毒性或疾病进展而未能完成 CT。12 例患者仅接受单药 CT，4 例患者因合并症而未接受 CT。2 例患者拒绝 CT。18 例患者术后因未接受 CT 而死亡。8 例患者因疾病进展或合并症而未进行细胞减灭术。NCCN 标准治疗组的 PFS 和 OS 均得到改善（PFS：5.7 与 18.3 个月，p<.005）（OS：11.4 与 49.5 个月，p<.005）。
大多数在 NCCN 癌症中心接受治疗的患者都接受了 NCCN 标准的治疗。未接受 NCCN 标准治疗的原因各不相同，但大多数患者因合并症或疾病进展而未按指南接受化疗。
