MANAGEMENT OF MALIGNANT TERATOMA - DOES REFERRAL TO A SPECIALIST UNIT MATTER
MANAGEMENT OF MALIGNANT TERATOMA - DOES REFERRAL TO A SPECIALIST UNIT MATTER
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DOI：
10.1016/0140-6736(93)91082-w
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发表时间：
1993-04-17
期刊：
影响因子：
168.9
通讯作者：
KAYE, SB
中科院分区：
文献类型：
--
作者：
HARDING, MJ;PAUL, J;KAYE, SB
英国不同地区癌症存活率的地理差异的原因尚不清楚。对苏格兰西部非精原细胞瘤(NSGCT)患者的治疗进行了基于人群的审计，使我们能够评估公认的预后因素、治疗中心和方案治疗对预后的相对贡献。对1975至1989年间确诊的454名NSGCT患者中的440人(97%)的治疗和结果数据进行了分析。除11名患者外，所有患者都在三级转诊中心接受治疗；235名患者在一个单元(第1单元)接受治疗，194名患者在其他4个单元(2-5)接受治疗。已有99名男性死亡，其中89人(20%)死于NSGCT。影响非小细胞肺癌生存的独立预后因素有：确诊时肿瘤范围(p<；0.001)、5年诊断期(1975年-1979年至1985年-1989年，p<；0.001)和治疗单位(1号单位vs 2-5号单位，p<；0.001)。存活率最高的单元1治疗了大多数患者(53%)，其中大多数(70%)属于预后最差的类别(预后不良的转移性疾病)。在1号病房接受全国性协议治疗的男性比例高于其他地方(97%vs61%，p<；0.0001)。然而，仅限于接受方案治疗的男性的分析，调整了其他重要的预后变量，仍然显示了这个单位的生存优势(相对死亡率单位2-5比单位1，2.82[95%CL1.53-5.19]，p<；0.001)。这些发现表明，非小细胞肺癌集中治疗改善了结果；这种好处似乎是附加于方案治疗所产生的任何优势。
The causes of geographical differences in cancer survival among regions of the UK are unclear. Population-based audit of management of patients with non-seminomatous germ-cell tumours (NSGCT) in the west of Scotland enabled us to assess the relative contributions to outcome of recognised prognostic factors, treatment centre, and protocol treatment.Data on treatment and outcome were analysed for 440 (97%) of 454 men with NSGCT diagnosed between 1975 and 1989. All but 11 patients were treated at tertiary referral centres; 235 were treated at a single unit (unit 1) and 194 at four other units (2-5). 99 men have died, 89 (20%) from NSGCT. Independent prognostic factors for NSGCT survival were extent of tumour at diagnosis (p < 0.001), 5-year period of diagnosis (from 1975-79 to 1985-89, p < 0.001), and treatment unit (unit 1 vs units 2-5, p < 0.001). Unit 1, which had the best survival rates, treated most patients overall (53%), including the majority (70%) in the worst prognostic category (poor-prognosis metastatic disease). The proportion of men receiving nationally agreed protocol treatment was higher at unit 1 than elsewhere (97 vs 61%, p < 0.0001). However, analysis restricted to men who received protocol treatment, Adjusted for other important prognostic variables, still showed a survival advantage for this unit (relative death rate units 2-5 vs unit 1, 2.82 [95% Cl 1.53-5.19], p < 0.001).These findings suggest that centralisation of treatment for NSGCT improves outcome; the benefit seems to be additional to any advantage resulting from protocol treatment.