Kehoe S, Powell J, Wilson S, Woodman C
Department of Obstetrics & Gynaecology, City Hospital, Birmingham, UK.
Br J Cancer. 1994 Nov;70(5):1014-7. doi: 10.1038/bjc.1994.440.
A retrospective analysis of ovarian cancer patients registered with the West Midlands Cancer Registry from 1 January 1985 to 31 December 1987 was undertaken to examine the variables associated with survival patterns, with particular reference to the specialty of the surgeon. A total of 1,654 patients were registered, of whom 1,184 had histologically confirmed ovarian cancer, with the operator identified. This consisted of 870 patients operated on by gynaecologists and 314 operated on by general surgeons. A significantly older population and a greater number of patients with stage III/IV disease were operated on by general surgeons. The median survival of patients under the general surgeons' care was 9.87 months, significantly lower (P < 0.0001) than the survival of the gynaecologists' patients (median survival = 29.1 months). Univariate and multivariate analysis correlated poor prognosis with advanced stage disease, older age, the presence of bulky residual tumour and a general surgeon as the operator. Stepwise Cox's proportional hazard analysis confirmed the general surgeon as an independent adverse prognostic factor with a relative hazard ratio of 1.34 (95% confidence interval = 1.05-1.71). Accepting the limitations of retrospective reviews, these findings suggest that every attempt be made to ensure that a gynaecologist is involved in the treatment of patients with ovarian pathology.
对1985年1月1日至1987年12月31日在西米德兰兹癌症登记处登记的卵巢癌患者进行了回顾性分析，以研究与生存模式相关的变量，特别提及外科医生的专业。总共登记了1654名患者，其中1184名经组织学确诊为卵巢癌，且已确定手术医生。这包括870名由妇科医生进行手术的患者和314名由普通外科医生进行手术的患者。普通外科医生所治疗的患者群体年龄显著更大，且III/IV期疾病患者数量更多。普通外科医生治疗的患者中位生存期为9.87个月，显著低于（P < 0.0001）妇科医生治疗患者的生存期（中位生存期 = 29.1个月）。单因素和多因素分析表明，预后不良与疾病晚期、年龄较大、存在大量残留肿瘤以及手术医生为普通外科医生有关。逐步Cox比例风险分析证实普通外科医生是一个独立的不良预后因素，相对风险比为1.34（95%置信区间 = 1.05 - 1.71）。尽管认识到回顾性研究的局限性，但这些发现表明应尽一切努力确保妇科医生参与卵巢疾病患者的治疗。
