Real-world evidence in the treatment of ovarian cancer
Real-world evidence in the treatment of ovarian cancer
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DOI：
10.1093/annonc/mdx443
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发表时间：
2017-11-01
影响因子：
50.5
通讯作者：
Eisenhauer, E. A.
中科院分区：
文献类型：
--
作者：
Eisenhauer, E. A.
“真实世界证据(RWE)”指的是有关新疗法和技术在临床实践中的使用和结果的信息。RWE可能包括单一机构队列研究、基于人群的卫生服务研究，或(国际)关于生存和死亡率的国家数据。本文综述了RWE对卵巢癌治疗的影响，并对有关卵巢癌新的外科和系统治疗干预措施的人群水平生存结果的文献进行了综述。此外，还汇编了有关卵巢癌存活率、死亡率和发病率的文献和国际癌症登记趋势。后者被用来推断新治疗方法的相对影响以及发病率的变化对观察到的死亡率趋势的影响。在过去的40年里，基于随机试验证据，卵巢癌的新的系统和手术治疗方法被引入实践。然而，关于人口水平的摄取和这些干预措施的生存结果的出版很少。关于腹膜腔内化疗和新辅助化疗的人群研究除外。一篇论文显示，腹膜腔内化疗的摄入量不大，而且有证据表明患者的存活率有所提高。癌症登记统计数据显示，在过去的三四十年里，欧洲、北美和其他地区的卵巢癌发病率不断下降(类似于每年1%-2%)。在此期间，死亡率也以每年1%-2%的速度下降。在此期间，人群5年相对生存率的估计也有所改善[从1975年的33.7%提高到2008年的46.2%(SEER数据)]。很少有RWE研究卵巢癌的特定治疗方法。相对存活率和人口死亡率的趋势有所改善。死亡率的变化可以部分解释为卵巢癌发病率的降低(推测是由于口服避孕药的使用和绝经后激素使用的减少)。然而，看似合理的是，至少部分死亡率的降低与引入有效的新治疗方法提高了患者的存活率有关。
'Real-world evidence (RWE)' refers to information on the utilization and outcome of new therapies and technologies in clinical practice. RWE may include single institution cohort studies, population-based health services studies, or (inter)national data on survival and mortality. This paper reviews RWE on the impact of treatment in ovarian cancer.A literature review of publications addressing population level survival outcomes of new surgical and systemic treatment interventions in ovarian cancer was undertaken. In addition, literature and international cancer registry trends in ovarian cancer survival, mortality and incidence rates were compiled. These latter were utilized to make inferences on the relative impact of new treatments as well as changing incidence rates on observed mortality trends.The last four decades have seen new systemic and surgical treatments introduced into practice for ovarian cancer based on randomized trial evidence. However, there has been little published on population level uptake and survival outcomes of those interventions. Exceptions were population studies on intraperitoneal chemotherapy and neoadjuvant chemotherapy. One paper demonstrated modest uptake of intraperitoneal chemotherapy and evidence of improved survival. Cancer registry statistics revealed falling incidence rates (similar to 1%-2% per year) for ovarian cancer across Europe, North America and elsewhere over the last three to four decades. Mortality rates also declined by similar to 1%-2% per year over this period. Population 5-year relative survival estimates also improved over this period [from 33.7% in 1975 to 46.2% in 2008 (SEER data)].There are few RWE studies of specific treatments in ovarian cancer. Trends in relative survival and population mortality have shown improvements. Mortality changes can be explained in part by reductions in ovarian cancer incidence rates (speculated to be due to use of oral contraceptives and reduction in postmenopausal hormone use). However, it is plausible that at least some of the mortality reduction is related to improved survival of patients with the introduction of effective new treatments.