Eggink F A, Mom C H, Kruitwagen R F, Reyners A K, Van Driel W J, Massuger L F, Niemeijer G C, Van der Zee A G, Van der Aa M A, Nijman H W
University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands.
Maastricht University Medical Center, Department of Obstetrics and Gynecology, Maastricht, The Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
Gynecol Oncol. 2016 Jun;141(3):524-530. doi: 10.1016/j.ygyno.2016.04.012. Epub 2016 Apr 23.
Objectives of this study were to evaluate the effect of changes in patterns of care, for example centralization and treatment sequence, on surgical outcome and survival in patients with epithelial ovarian cancer (EOC).
Patients diagnosed with FIGO stage IIB-IV EOC (2004-2013) were selected from the Netherlands Cancer Registry. Primary outcomes were surgical outcome (extent of macroscopic residual tumor after surgery) and overall survival. Changes in treatment sequence (primary debulking surgery and adjuvant chemotherapy (PDS+ACT) or neo-adjuvant chemotherapy and interval debulking surgery (NACT+IDS)), hospital type and annual hospital volume were also evaluated.
Patient and tumor characteristics of 7987 patients were retrieved. Most patients were diagnosed with stage III-IV EOC. The average annual case-load per hospital increased from 8 to 28. More patients received an optimal cytoreduction (tumor residue≤1cm) in 2013 (87%) compared to 2004 (55%, p<0.001). Complete cytoreduction (no macroscopic residual tumor), registered since 2010, increased from 42% to 52% (2010 and 2013, respectively, p<0.001). Optimal/complete cytoreduction was achieved in 85% in high volume (≥20 cytoreductive surgeries annually), 80% in medium (10-19 surgeries) and 71% in small hospitals (<10 surgeries, p<0.001). Within a selection of patients with advanced stage disease that underwent surgery the proportion of patients undergoing NACT+IDS increased from 28% (2004) to 71% (2013). Between 2004 and 2013 a 3% annual reduction in risk of death was observed (HR 0.97, p<0.001).
Changes in pattern of care for patients with EOC in the Netherlands have led to improvement in surgical outcome and survival.
本研究的目的是评估护理模式的变化，例如集中化和治疗顺序，对上皮性卵巢癌（EOC）患者手术结局和生存的影响。
从荷兰癌症登记处选取2004年至2013年诊断为国际妇产科联盟（FIGO）IIB-IV期EOC的患者。主要结局为手术结局（手术后宏观残留肿瘤的范围）和总生存。还评估了治疗顺序的变化（初次肿瘤细胞减灭术和辅助化疗（PDS+ACT）或新辅助化疗和间隔肿瘤细胞减灭术（NACT+IDS））、医院类型和年度医院工作量。
检索了7987例患者的患者和肿瘤特征。大多数患者诊断为III-IV期EOC。每家医院的年均病例数从8例增加到28例。与2004年（55%，p<0.001）相比，2013年更多患者实现了最佳肿瘤细胞减灭（肿瘤残留≤1cm）（87%）。自2010年开始记录的完全肿瘤细胞减灭（无宏观残留肿瘤）从42%增加到52%（分别为2010年和2013年，p<0.001）。在高工作量医院（每年≥20例肿瘤细胞减灭手术）中，85%的患者实现了最佳/完全肿瘤细胞减灭，中等工作量医院（10-19例手术）为80%，小医院（<10例手术）为71%（p<0.001）。在接受手术的晚期疾病患者中，接受NACT+IDS的患者比例从2004年的28%增加到2013年的71%。2004年至2013年期间，观察到每年死亡风险降低3%（风险比0.97，p<0.001）。
荷兰EOC患者护理模式的变化导致了手术结局和生存的改善。
