Wolfe C D, Tilling K, Bourne H M, Raju K S
Division of Public Health Sciences, United Medical and Dental Schools of Guys and St. Thomas' Hospitals, London, U.K.
Eur J Cancer. 1996 Jun;32A(7):1198-204. doi: 10.1016/0959-8049(96)00038-x.
In seven health districts in southern England, an audit of the management of cervical cancer compared with regionally developed guidelines was undertaken between 1988 and 1991. Four hundred and sixty-nine regional residents were treated in the study district hospitals. 73 (15.6%) women were appropriately staged, with increasing likelihood of appropriate staging investigations observed with higher stages (P < 0.0001) and type of hospital [Teaching 23 (21%), Non-Teaching with oncology support 11 (11.5%), Non-teaching 4 (7%), P < 0.0001] but with no change over the study period. There was no significant trend in the proportion of women treated appropriately over time, with 270 (59%) being appropriately treated, 91 (20%) under-treated and 98 (21%) over-treated overall. Appropriateness of treatment increased with higher stages (P < 0.0001) and hospital workload for cancer of the cervix (P = 0.038). Multivariable analysis indicated that survival independently and significantly decreased with age and stage, under-treatment and in cases where lymph nodes were involved or not examined. There was no change in the appropriateness of management over the 4 years, with high levels of inappropriate care. Survival was not only influenced by biological and demographic factors, but by inappropriate care.
1988年至1991年间，在英格兰南部的七个卫生区，开展了一项关于宫颈癌管理的审计，将其与区域制定的指南进行比较。469名该区域居民在研究区域的医院接受了治疗。73名（15.6%）女性分期恰当，且随着分期升高（P<0.0001）以及医院类型不同（教学医院23名[21%]，有肿瘤学支持的非教学医院11名[11.5%]，非教学医院4名[7%]，P<0.0001），恰当分期检查的可能性增加，但在研究期间没有变化。随着时间推移，接受恰当治疗的女性比例没有显著趋势，总体上270名（59%）得到恰当治疗，91名（20%）治疗不足，98名（21%）治疗过度。治疗的恰当性随着分期升高（P<0.0001）以及子宫颈癌的医院工作量增加（P = 0.038）而提高。多变量分析表明，生存率随着年龄、分期、治疗不足以及淋巴结受累或未检查的情况而独立且显著降低。在这4年中，管理的恰当性没有变化，存在大量不恰当的治疗。生存率不仅受到生物学和人口统计学因素的影响，还受到不恰当治疗的影响。
