背景:高复杂性和低患病率的手术受益于转诊中心的治疗。目前尚不清楚维持妇科肉瘤的高训练所需的病例量。这项研究旨在确定生存率和复发率的差异,作为每个中心治疗的患者数量的函数。
方法:子宫SARComa(SARCUT)的多中心横断面研究回顾性收集了2001年1月至2007年12月来自欧洲44个中心的子宫肉瘤病例。将在高病例量(HighCV)中心治疗的患者的生存率与在低病例量(LowCV)中心治疗的患者的生存率进行比较。
结果:该研究招募了966名患者:LowCV组753名,HighCV组213名。总生存期(OS)为117个月,癌症特异性生存期(CSS)为126个月。差异是显著的(分别为p=0.0003和0.0004,对数秩)。在对其他混杂因素进行调整后,其余重要因素是年龄(危险比[HR],1.04;95%置信区间[CI],1.03-1.05),组织学(HR,1.19;95%CI,1.06-1.34),宫外受累(HR,1.61;95%CI,1.24-2.10)和治疗后的持续性疾病(HR,3.22;95%CI,2.49-4.18)。在两组中进行的细胞减少与CSS和OS显着相关。手术细胞还原的对数等级是低于OS的0.0001的p值,LowCV中心低于0.0001,和0.0032的HighCV中心。
结论:子宫肉瘤患者的预后与肿瘤完全减瘤作用直接相关,组织学类型,和FIGO阶段,低案量中心和高案量中心之间存在显着差异。子宫肉瘤患者应集中在HighCV中心,以改善其肿瘤预后。
BACKGROUND: High-complexity and low-prevalence procedures benefit from treatment by referral centers. The volume of cases necessary to maintain high training in the treatment of gynecologic sarcoma is currently unknown. This study aimed to determine differences in survival and recurrence as a function of the volume of patients treated per center.
METHODS: The multicentric cross-sectional SARComa of the Uterus (SARCUT) study retrospectively collected cases of uterine sarcomas from 44 centers in Europe from January 2001 to December 2007. The survival of patients treated in high
case-volume (HighCV) centers was compared with the survival of patients treated in low
case-volume (LowCV) centers.
RESULTS: The study enrolled 966 patients: 753 in the LowCV group and 213 in the HighCV. Overall survival (OS) was 117 months, and cancer-specific survival (CSS) was 126 months. The difference was significant (respectively p = 0.0003 and 0.0004, log rank). After adjustment for other confounding factors, the remaining significant factors were age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.03-1.05), histology (HR, 1.19; 95% CI, 1.06-1.34), extrauterine involvement (HR, 1.61; 95% CI, 1.24-2.10) and persistent disease after treatment (HR, 3.22; 95% CI, 2.49-4.18). The cytoreduction performed was significantly associated with the CSS and OS in both groups. The log rank for surgical cytoreduction was a p value lower than 0.0001 for OS, lower than 0.0001 for the LowCV centers, and 0.0032 for the HighCV centers.
CONCLUSIONS: The prognosis for patients with uterine sarcoma is directly related to complete tumor cytoreduction, histologic type, and FIGO stage, with significant differences between low and high
case-volume centers. Patients with uterine sarcomas should be centralized in HighCV centers to improve their oncologic outcomes.