探讨医院登记数据在展示当地服务成果方面的附加价值：卵巢、输卵管和腹膜癌。
Exploring the added value of hospital-registry data for showing local service outcomes: cancers of the ovary, fallopian tube and peritoneum.
机构信息
Cancer Epidemiology and Population Health, University of South Australia, Adelaide, South Australia, Australia.
Private Consultant, Norwood, South Australia, Australia.
出版信息
BMJ Open. 2019 Feb 19;9(2):e024036. doi: 10.1136/bmjopen-2018-024036.
OBJECTIVES
To explore the added value of hospital-registry data on invasive epithelial ovarian, tubal and peritoneal cancers.
DESIGN
Historic cohort analyses.
METHODS
Unadjusted and adjusted regression.
SETTING
Major South Australian hospitals.
PARTICIPANTS
1596 women (1984-2015 diagnoses).
RESULTS
5-Year and 10-year survival was 48% and 41%, respectively, equivalent to relative survival for Australia and the USA. After adjusting for age, clinical and geographic factors, risk of ovarian cancer death was 25% lower in 2010-2015 than 1984-1989. Women generally had surgical treatment (87%) in their first round of care. This was more common for younger patients (adjusted OR (95% CIs) 0.17 (0.04 to 0.65) for 80+ vs <40 years) and earlier International Federation of Gynecology and Obstetrics stages (adjusted OR 0.48 (0.13 to 1.78) for stage IIIB/C and 0.13 (0.04 to 0.45) for stage IV vs stage IA). Most (74%) had systemic therapy, which was more common for advanced stages (adjusted ORs >15.0 for stages III and IV vs stage IA). Few (9%) had radiotherapy. Women generally had systemic therapy (74%), without difference by service accessibility and socioeconomic disadvantage, suggesting equity. However, surgery was less common for residents of the most compared with least remote areas (adjusted OR 0.49 (0.24 to 0.99)); and more common prior to adjustment in the highest versus lowest socioeconomic category (unadjusted OR 1.55 (1.01 to 2.39)), but this elevation did not apply after adjustment (adjusted OR 0.19 (0.63 to 2.25)), with the difference largely explained by stage.
CONCLUSIONS
Hospital-registry data add value for assessing local service delivery. Equivalent survival to Australia-wide and USA survival, and temporal gains after adjusting for stage and other patient characteristics are reassuring. Survival gains may reflect therapeutic benefits of more extensive surgery and improved chemotherapy regimens.
目的
探讨医院登记数据对侵袭性上皮性卵巢癌、输卵管癌和腹膜癌的附加价值。
设计
回顾性队列分析。
方法
未调整和调整后的回归。
地点
南澳大利亚州主要医院。
参与者
1596 名女性（1984-2015 年诊断）。
结果
5 年和 10 年生存率分别为 48%和 41%，与澳大利亚和美国的相对生存率相当。调整年龄、临床和地理因素后，2010-2015 年卵巢癌死亡风险比 1984-1989 年降低 25%。女性通常在第一轮治疗中接受手术治疗（87%）。这在年轻患者中更为常见（调整后的 OR（95%CI）为 0.17（0.04 至 0.65），80 岁以上 vs <40 岁）和更早的国际妇产科联合会（FIGO）分期（调整后的 OR 0.48（0.13 至 1.78）为 IIIB/C 期和 0.13（0.04 至 0.45）期，IV 期 vs I 期）。大多数（74%）接受了系统治疗，晚期（调整后的 OR ＞15.0 用于 III 和 IV 期 vs I 期）患者更为常见。（9%）接受了放疗。女性通常接受系统治疗（74%），按服务可及性和社会经济劣势没有差异，表明公平。然而，与最偏远地区相比，最偏远地区的居民接受手术治疗的比例较低（调整后的 OR 0.49（0.24 至 0.99））；在最高和最低社会经济类别中，在调整前更常见（未调整的 OR 1.55（1.01 至 2.39）），但调整后这一升高并不适用（调整后的 OR 0.19（0.63 至 2.25）），差异主要由分期解释。
结论
医院登记数据对评估当地服务提供情况具有附加价值。与澳大利亚和美国的生存率相当，并且在调整分期和其他患者特征后获得了生存获益，这令人放心。生存获益可能反映了更广泛的手术和改进的化疗方案带来的治疗益处。
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