Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands; Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht, The Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.
Gynecol Oncol. 2018 Jan;148(1):56-61. doi: 10.1016/j.ygyno.2017.11.009. Epub 2017 Nov 10.
Surgical care for advanced stage epithelial ovarian cancer (EOC) patients has been centralized in the Netherlands since 2012. We evaluated whether the likelihood for patients to undergo surgery depends on the hospital of initial diagnosis before and after centralization of surgical care.
Patients with EOC FIGO stage IIB-IV, diagnosed in the Netherlands between 2000 and 2015, were identified from the Netherlands Cancer Registry. Multilevel multivariate logistic regression was used to study the association between hospital of diagnosis and patients' likelihood of undergoing surgery in subsequent time periods. Furthermore, changes in overall survival were analyzed by multivariable Cox regression models.
15,314 EOC patients were selected from the NCR. Hospital of diagnosis was identified as a significant level for patients' likelihood of undergoing surgery in 2000-2005 (LR test p<0.001), as well as in 2006-2011 (LR test p=0.002) but not in 2012-2015 (LR test p=0.127). Patients who underwent surgery in 2012-2015 had a better survival when compared to 2006-2011 (HR 0.90(0.84-0.96)).
This study shows that centralization of surgical care resolved the variation between hospitals in the probability to undergo cytoreductive surgery for patients with advanced EOC. Since centralization was established in 2012, the decision to operate patients seems solely attributable to patient and tumor characteristics. This supports the growing evidence in favor of centralizing (surgical) treatment for complex and heterogeneous diseases such as EOC.
自 2012 年以来，荷兰已经将晚期上皮性卵巢癌（EOC）患者的外科治疗集中化。我们评估了在外科治疗集中化之前和之后，患者接受手术的可能性是否取决于初始诊断的医院。
从荷兰癌症登记处确定了 2000 年至 2015 年间在荷兰诊断为 FIGO 分期 IIB-IV 期的上皮性卵巢癌患者。使用多水平多变量逻辑回归研究了诊断医院与患者随后手术可能性之间的关联。此外，通过多变量 Cox 回归模型分析了总生存率的变化。
从 NCR 中选择了 15314 名上皮性卵巢癌患者。诊断医院被确定为 2000-2005 年（LR 检验 p<0.001）以及 2006-2011 年（LR 检验 p=0.002）患者接受手术可能性的显著水平，但在 2012-2015 年（LR 检验 p=0.127）则不然。与 2006-2011 年相比，2012-2015 年接受手术的患者生存情况更好（HR 0.90（0.84-0.96））。
本研究表明，外科治疗的集中化解决了晚期上皮性卵巢癌患者接受细胞减灭术的概率在医院之间的差异。自 2012 年集中化建立以来，对患者进行手术的决策似乎仅归因于患者和肿瘤特征。这支持了越来越多的证据，即支持将复杂和异质疾病（如上皮性卵巢癌）的治疗集中化（手术）。
