Influence of Gynecologic Oncologists on the Survival of Patients With Endometrial Cancer
Influence of Gynecologic Oncologists on the Survival of Patients With Endometrial Cancer
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DOI：
10.1200/jco.2010.31.2124
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发表时间：
2011-03-01
影响因子：
45.3
通讯作者：
Deshmukh, Harshal
中科院分区：
文献类型：
--
作者：
Chan, John K.;Sherman, Alexander E.;Deshmukh, Harshal
目的尽管缺乏证据证明子宫内膜癌的生存益处，美国妇产科学会仍建议将子宫内膜癌患者转诊至妇科肿瘤专家进行治疗。因此，我们建议，以确定妇科肿瘤学家的治疗和生存的子宫内膜cancer.Patients和方法数据的影响，从医疗保险和监测，流行病学和最终结果（SEER）数据库，从1988年至2005年。结果在18,338名妇女中，21.4%的妇女接受了妇科肿瘤医生的治疗（A组），78.6%的妇女接受了其他治疗（B组）。A组女性年龄较大，（年龄> 71岁：49.6%对44%; P < .001），切除的淋巴结更多（> 16个）（22%对17%; P < .001），表现为更晚期（III至IV期）癌症（21.9%对14.6%; P <0.001），具有更高级别的肿瘤（P <0.001），并且更可能接受晚期疾病的化疗（22.6%对12.4%; P <0.001）。在II至IV期疾病患者中，A组的5年疾病特异性生存率（DSS）为79%，而B组为73%（P = 0.001）。此外，在晚期（III至IV期）疾病中，A组的5年DSS为72%，而B组为64%（P < .001）。然而，在I期癌症中没有发现与DSS的关联。多因素分析，年龄小，早期，低级别，并由妇科肿瘤医生治疗是独立的预后因素，为提高survival.Conclusion妇科肿瘤医生治疗的子宫内膜癌患者更有可能接受分期手术，并接受辅助化疗晚期疾病。妇科肿瘤学家提供的护理提高了高危癌症患者的生存率。J Clin Oncol 29：832-838. (C)2011年美国临床肿瘤学会
Purpose Despite a lack of evidence for survival benefit, the American College of Obstetrics and Gynecology has recommendations for referral to gynecologic oncologists for the treatment of endometrial cancer. Therefore, we propose to determine the influence of gynecologic oncologists on the treatment and survival of patients with endometrial cancer.Patients and Methods Data were obtained from Medicare and Surveillance, Epidemiology, and End Results (SEER) databases from 1988 to 2005. Kaplan-Meier and Cox proportional hazard methods were used for analyses.Results Of 18,338 women, 21.4% received care from gynecologic oncologists (group A) while 78.6% were treated by others (group B). Women in group A were older (age > 71 years: 49.6% v 44%; P < .001), had more lymph nodes (> 16) removed (22% v 17%; P < .001), presented with more advanced (stages III to IV) cancers (21.9% v 14.6%; P < .001), had higher-grade tumors (P < .001), and were more likely to receive chemotherapy for advanced disease (22.6% v 12.4%; P < .001). In those with stages II to IV disease, the 5-year disease-specific survival (DSS) of group A was 79% versus 73% in group B (P = .001). Moreover, in advanced-stage (III to IV) disease, group A had 5-year DSS of 72% versus 64% in group B (P < .001). However, no association with DSS was identified in stage I cancers. On multivariable analysis, younger age, early stage, lower grade, and treatment by gynecologic oncologists were independent prognostic factors for improved survival.Conclusion Patients with endometrial cancer treated by gynecologic oncologists were more likely to undergo staging surgery and receive adjuvant chemotherapy for advanced disease. Care provided by gynecologic oncologists improved the survival of those with high-risk cancers. J Clin Oncol 29:832-838. (C) 2011 by American Society of Clinical Oncology