Seror Julien, Guillot Eugénie, Genin Anne-Sophie, Hequet Delphine, Pouget Nicolas, Dubot Coraline, Rouzier Roman
Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France.
Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France.
Bull Cancer. 2016 Jun;103(6):513-23. doi: 10.1016/j.bulcan.2016.03.010. Epub 2016 May 26.
The "Institut national du cancer" has established since 2007 a minimum threshold of 20 patients per year per center to treat patients with gynecologic cancer. This review aims to assess whether the literature data validate this approach, and specifically for ovarian cancer.
A search of the MEDLINE database was conducted, to reference all relevant articles evaluating one hand the links between the survival of patients with ovarian cancer and the average volume of patients per center and by operator; and secondly the relationship between quality of oncological surgery and these volumes.
Nineteen studies met our inclusion criteria; seventeen were retrospective and two were prospective; population samples ranged from 476 to 96,802 patients. The most important data, quantitatively and qualitatively, concern the evaluation of survival based on the average volume per center, with 8 out of 13 studies finding a statistically significant correlation between average volume per center and survival. Data on the quality of surgery are less abundant and more heterogeneous, depending on the definition of the "optimal" surgery by the authors.
The establishment of threshold centers appears to be an effective way to improve survival in ovarian cancer. However, these thresholds would have to be specific to ovarian cancer and not extended to "gynecological cancers."
自2007年起，“法国国立癌症研究所”规定每个中心每年治疗妇科癌症患者的最低阈值为20例。本综述旨在评估文献数据是否验证了这种方法，特别是针对卵巢癌。
对MEDLINE数据库进行检索，以引用所有相关文章，一方面评估卵巢癌患者生存率与每个中心及每位手术医生的平均患者量之间的联系；另一方面评估肿瘤手术质量与这些患者量之间的关系。
19项研究符合我们的纳入标准；17项为回顾性研究，2项为前瞻性研究；样本量从476例至96,802例患者不等。在数量和质量方面，最重要的数据涉及基于每个中心平均患者量对生存率的评估，13项研究中有8项发现每个中心平均患者量与生存率之间存在统计学显著相关性。关于手术质量的数据较少且更为异质，这取决于作者对“最佳”手术的定义。
设立阈值中心似乎是提高卵巢癌患者生存率的有效方法。然而，这些阈值必须针对卵巢癌，而不应扩展至“妇科癌症”。
