What are the current surgical objectives, strategies, and technical capabilities of gynecologic oncologists treating advanced epithelial ovarian cancer?
What are the current surgical objectives, strategies, and technical capabilities of gynecologic oncologists treating advanced epithelial ovarian cancer?
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DOI：
10.1006/gyno.2001.6312
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发表时间：
2001-09-01
影响因子：
4.7
通讯作者：
Spirtos, NM
中科院分区：
文献类型：
--
作者：
Eisenkop, SM;Spirtos, NM
Objective.本调查的目的是确定由妇科肿瘤学家进行的原发性肿瘤细胞减灭术的手术目标、策略和结果。一项针对“最佳”细胞减灭术的定义、新辅助化疗的使用、排除最佳细胞减灭术的疾病部位、最佳细胞减灭术或细胞减灭术达到或未达到明显无病结局的原因、15种特定手术程序的使用的调查，以及对晚期上皮性卵巢癌外科治疗后培训的态度，妇科肿瘤学家协会离散和二项数据的分析采用卡方检验（2）和独立样本t检验。Logistic回归分析证实了反应与最佳细胞减灭术的定义和对奖学金后培训的态度之间的关系。640名医生中有393名（61.4%）提供了可用数据。据报道，95%的患者接受了初次手术，5%的患者接受了新辅助化疗（P < 0.0001）。使用了9例（范围0-15）调查手术的中位数。47名（12.0%）受访者将最佳细胞减灭定义为无残留病变，54名（13.7%）使用5 mm阈值，239名（60.8%）使用1 cm阈值，48名（12.6%）使用1.5- 2.0 cm阈值。残留病灶的小尺寸（0-5 mm与1-2 em）定义了医生的最佳细胞减灭术，表明较少的病变部位排除了最佳细胞减灭术（P = 0.02），使用了大量的调查手术（P = 0.04），实际上更长（P = 0.001）。378名受访者中有317名（83.9%）赞成发展细胞减灭术的博士后培训。反对研究后培训的医生使用较少的调查程序，因为对疗效的关注（P = 0.01）。近期研究生更倾向于研究生培训（P = 0.01）。妇科肿瘤学家之间存在一系列的手术目标，策略，使用的程序和结果。肿瘤细胞减灭术的疗效的确认可能会培养关于晚期卵巢癌最合适的治疗目标和策略的共识。应开展合作努力，提供研究金后培训。(C)北京：科学出版社.
Objective. The purpose of this survey was to determine the range of surgical objectives, strategies, and outcomes of primary cytoreductive operations performed by gynecologic oncologists.Methods. A survey addressing the definition of "optimal" cytoreduction, the use of neoadjuvant chemotherapy, disease sites precluding optimal cytoreduction, reasons optimal cytoreduction or cytoreduction to a visibly disease-free outcome is or is not accomplished, the use of 15 specific operative procedures, and attitude toward postfellowship training in the surgical management of advanced stage epithelial ovarian cancer was mailed to candidate and full members of the Society of Gynecologic Oncologists. Analysis of discrete and binomial data utilized the chi (2) and independent samples t tests. Logistic regression confirmed relationships between responses and both the definition of optimal cytoreduction and the attitudes toward postfellowship training.Results. Three hundred ninety-three (61.4%) of 640 physicians provided utilizable data. A median of 95% of patients were reported to be operated on primarily and 5% were treated with neoadjuvant chemotherapy (P < 0.0001). A median of 9 (range 0-15) of the surveyed procedures were utilized. Forty-seven (12.0%) respondents defined optimal cytoreduction as no residual disease, 54 (13.7%) used a 5-mm threshold, 239 (60.8%) used a 1-cm threshold, and 48 (12.6%) utilized a 1.5- to 2.0-cm threshold. Small dimensions of residual disease (0-5 mm versus 1-2 em) defined optimal cytoreduction for physicians indicating that fewer disease sites precluded optimal cytoreduction (P = 0.02), using a larger number of the surveyed procedures (P = 0.04), and in practice longer (P = 0.001). Three hundred seventeen (83.9%) of 378 respondents favored development of postfellowship training in cytoreductive surgery. Physicians against postfellowship training used fewer of the surveyed procedures because of concerns about efficacy (P = 0.01). More recent fellowship graduates favored postfellowship training (P = 0.01).Conclusions. A range of surgical objectives, strategies, procedures used, and outcomes exists among gynecologic oncologists. Confirmation of the efficacy of cytoreductive surgery may cultivate a consensus about the most appropriate therapeutic objective and strategy for advanced ovarian cancer. Cooperative efforts should be undertaken to offer postfellowship training. (C) 2001 Academic Press.