Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinoma
| Autor: | Jan G. Aalders, Ate G.J. van der Zee, Elisabeth G.E. de Vries, Mirjam J. A. Engelen, Michael Schaapveld, Renée Otter, Henrike E. Kos, Pax H.B. Willemse |
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| Přispěvatelé: | Targeted Gynaecologic Oncology (TARGON), Guided Treatment in Optimal Selected Cancer Patients (GUTS) |
| Jazyk: | angličtina |
| Rok vydání: | 2006 |
| Předmět: |
Male
Cancer Research medical oncologist IMPACT Professional Competence Ovarian carcinoma primary surgery Stage (cooking) Referral and Consultation SPECIALIZATION Aged 80 and over Ovarian Neoplasms gynecologic carcinoma Hazard ratio Age Factors WOMEN Middle Aged CHEMOTHERAPY Treatment Outcome Oncology Medicine Regression Analysis Female Adult medicine.medical_specialty gynecologic oncologist ORGANIZATION general gynecologist VALIDATION medicine MANAGEMENT Humans patterns of care CANCER PATIENTS Survival analysis METAANALYSIS Aged Neoplasm Staging Retrospective Studies Patient Care Team Proportional hazards model business.industry Carcinoma Cancer Retrospective cohort study medicine.disease Survival Analysis Surgery Gynecology CYTOREDUCTIVE SURGERY business Gynecologic Oncologist |
| Zdroj: | Cancer, 106(3), 589-598. Wiley |
| ISSN: | 1097-0142 0008-543X |
| Popis: | BACKGROUND Consultant gynecologic oncologists from the regional Comprehensive Cancer Center assisted community gynecologists in the surgical treatment of patients with ovarian carcinoma when they were invited. For this report, the authors evaluated the effects of primary surgery by a gynecologic oncologist on treatment outcome. METHODS The hospital files from 680 patients with epithelial ovarian carcinoma who were diagnosed between 1994 and 1997 in the northern part of the Netherlands were abstracted. Treatment results were analyzed according to the operating physician's education by using survival curves and univariate and multivariate Cox regression analyses. RESULTS Primary surgery was performed on 184 patients by gynecologic oncologists, and on 328 patients by general gynecologists. Gynecologic oncologists followed surgical guidelines more strictly compared with general gynecologists (patients with International Federation of Gynecology and Obstetrics [FIGO] Stage I–II disease, 55% vs. 33% [P = 0.01]; patients with FIGO Stage III disease, 60% vs. 40% [P = 0.003]) and more often removed all macroscopic tumor in patients with FIGO Stage III disease (24% vs. 12%; P = 0.02). When patients were stratified according to FIGO stage, the 5-year overall survival rate was 86% versus 70% (P = 0.03) for patients with Stage I–II disease and 21% versus 13% (P = 0.02) for patients with Stage III–IV disease who underwent surgery by gynecologic oncologists and general gynecologists, respectively. The hazards ratio for patients who underwent surgery by gynecologic oncologists was 0.79 (95% confidence interval [95%CI], 0.61–1.03; adjusted for patient age, disease stage, type of hospital, and chemotherapy); when patients age 75 years and older were excluded, the hazards ratio fell to 0.71 (95% CI, 0.54–0.94) in multivariate analysis. CONCLUSIONS The surgical treatment of patients with ovarian carcinoma by gynecologic oncologists occurred more often according to surgical guidelines, tumor removal more often was complete, and survival was improved. Cancer 2006. © 2005 American Cancer Society. |
| Databáze: | OpenAIRE |
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