Ivanova Vesela, Dikov Tihomir, Dimitrova Nadya
Department of General and Clinical Pathology, Medical University, Sofia - Bulgaria.
National Hospital of Oncology, Bulgarian National Cancer Registry, Sofia - Bulgaria.
Tumori. 2017 Mar 24;103(2):148-154. doi: 10.5301/tj.5000571. Epub 2016 Oct 8.
To provide an overview of the morphologic subtypes of ovarian carcinomas in Bulgaria in relation to current healthcare organization using Bulgarian National Cancer Registry data. Further, we investigated hospital volume as a factor influencing the quality of care for patients with ovarian cancer.
Bulgarian National Cancer Registry ovarian carcinoma data were retrieved (2009-2011) and distribution of histologic types was analyzed. Cases were divided and compared with respect to main treatment: no surgery, surgery at hospitals dealing with ≥30 ovarian cancer patients/year (high volume), and surgery at hospitals dealing with <30 ovarian cancer patients/year (low volume). We then estimated the odds of being diagnosed with adenocarcinoma and carcinoma not otherwise specified (NOS) vs specified morphologies (serous, endometrioid, clear cell, and mucinous), including age, grade, stage, and hospital volume, in a logistic regression model.
A total of 2,041 ovarian carcinomas were distributed as follows: serous 47.7%, mucinous 11.9%, endometrioid 5.8%, clear cell 1.8%, and adenocarcinoma and carcinoma NOS 32.5%. More than half of cancer patients (n = 1,100, 53.9%) were surgically treated in low-volume hospitals and they had a larger proportion of cases with adenocarcinoma and carcinoma NOS: 33.3%, in comparison with 24.0% in high-volume hospitals (p<0.0001). The odds of being diagnosed with unspecified morphology, assumed as a proxy of suboptimal quality of care, are higher for patients surgically treated in low-volume hospitals (odds ratio 1.50 [95% confidence interval 1.21-1.87]) compared with high-volume hospitals after adjustment for age, stage, and grade.
The results of our study may serve policymakers and healthcare professionals when optimizing diagnosis and treatment of ovarian cancer in Bulgaria.
利用保加利亚国家癌症登记处的数据，概述保加利亚卵巢癌的形态学亚型与当前医疗保健组织的关系。此外，我们调查了医院规模作为影响卵巢癌患者护理质量的一个因素。
检索保加利亚国家癌症登记处的卵巢癌数据（2009 - 2011年），并分析组织学类型的分布。根据主要治疗方式对病例进行划分和比较：未手术、在每年处理≥30例卵巢癌患者的医院进行手术（高容量医院），以及在每年处理<30例卵巢癌患者的医院进行手术（低容量医院）。然后，我们在逻辑回归模型中估计了被诊断为腺癌和未另行指定的癌（NOS）与特定形态（浆液性、子宫内膜样、透明细胞和黏液性）的几率，包括年龄、分级、分期和医院规模。
总共2041例卵巢癌的分布如下：浆液性47.7%，黏液性11.9%，子宫内膜样5.8%，透明细胞1.8%，腺癌和癌NOS 32.5%。超过一半的癌症患者（n = 1100，53.9%）在低容量医院接受手术治疗，他们患腺癌和癌NOS的病例比例更高：33.3%，而高容量医院为24.0%（p<0.0001）。在调整年龄、分期和分级后，与高容量医院相比，在低容量医院接受手术治疗的患者被诊断为未指定形态（被认为是护理质量欠佳的指标）的几率更高（优势比1.50 [95%置信区间1.21 - 1.87]）。
我们的研究结果可为保加利亚优化卵巢癌的诊断和治疗时的政策制定者和医疗保健专业人员提供参考。
