Hematologist/oncologist disease-specific expertise and survival: lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL).
Hematologist/oncologist disease-specific expertise and survival: lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL).
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作者：
Shanafelt TD;Kay NE;Rabe KG;Inwards DJ;Zent CS;Leis JF;Schwager SM;Thompson CA;Bowen DA;Witzig TE;Slager SL;Call TG
医生的疾病特异性专业知识对患者结局的影响尚不清楚。虽然以前的研究表明，在高容量中心接受治疗的癌症患者具有生存优势，但这些观察结果可能只是反映了转诊偏倚或更好地获得大型中心的先进技术，临床试验和多学科支持。我们评估了一个学术中心新诊断的慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL）患者的首次治疗时间（TTFT）和总生存期（OS），这是基于他们是否由CLL专科的血液学家/肿瘤学家（CLL血液学家）或具有其他领域专业知识的血液学家/肿瘤学家（非CLL血液学家）治疗。在1999-2009年期间接受治疗的1309例新诊断的CLL患者中，773例（59%）由CLL血液学家治疗，536例由非CLL血液学家治疗。在早期患者（Rai 0-I）中，中位TTFT（9.2 vs. 6.1年; p<0.001）和OS（10.5年vs. 8.8年; p<0.001）上级CLL血液学家治疗的患者。对于所有患者，由CLL血液学家治疗的患者的OS上级（10.5年vs. 8.4年; p=0.001）。在调整年龄、分期、性别和淋巴细胞计数后，医生的疾病特异性专业知识仍然是OS的独立预测因素。CLL血液学家所见的患者也更有可能参与临床试验（48% vs. 16%; p<0.001）。医生的疾病特异性专业知识似乎会影响CLL患者的结局。在最大程度上，患者应由血液学家/肿瘤学家专家在其特定恶性肿瘤的护理中进行护理。如果不可能，应遵循特定疾病专家制定的实践指南。
The impact of physicians’ disease-specific expertise on patient outcome is unknown. While previous studies suggest a survival advantage for cancer patients cared for at high volume centers, these observations may simply reflect referral bias or better access to advanced technologies, clinical trials, and multidisciplinary support at large centers. We evaluated time to first treatment(TTFT) and overall survival(OS) of patients with newly diagnosed chronic lymphocytic leukemia/small lymphocytic lymphoma(CLL) at a single academic center based on whether they were cared for by a hematologist/oncologist who sub-specializes in CLL(CLL hematologist) or a hematologist/oncologist with expertise in other areas(non-CLL hematologist). Among 1309 newly diagnosed patients with CLL cared for between 1999–2009, 773(59%) were cared for by CLL hematologists and 536 were cared for by non-CLL hematologists. Among early stage patients(Rai 0-I), median TTFT(9.2 vs. 6.1 years; p<0.001) and OS(10.5 years vs. 8.8 years; p<0.001) were superior for patients cared for by CLL hematologists. For all patients, OS was superior for patients cared for by CLL hematologists(10.5 years vs. 8.4 years; p=0.001). Physician’s disease-specific expertise remained an independent predictor of OS after adjusting for age, stage, sex, and lymphocyte count. Patients seen by a CLL hematologist were also more likely participate in clinical trials(48% vs. 16%; p<0.001). Physician disease-specific expertise appears to influence outcome in patients with CLL. To the greatest extent possible, patients should be cared for by a hematologist/oncologist expert in the care of their specific malignancy. When not possible, practice guidelines developed by disease-specific experts should be followed.
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