Objective. To evaluate treatment outcomes in women with early-stage endometrial cancer (FIGO IA, IB, IC, or IIA)-surgically managed by a general gynecologist (GYN) or a gynecologic oncologist (GYO). Methods and result...Objective. To evaluate treatment outcomes in women with early-stage endometrial cancer (FIGO IA, IB, IC, or IIA)-surgically managed by a general gynecologist (GYN) or a gynecologic oncologist (GYO). Methods and results. 349 women treated from 1990-2003 were studied. Median follow-up was 3.7 years. Ninety-five were classified as highintermediate risk (HIR: stages IB grade III, IC grade II or III, any stage IIA). 110 women received adjuvant radiotherapy. The GYO group had more unfavorable tumor characteristics based on stage and grade (P < 0.0001), shorter follow-up (median 3.1 vs. 5.1 years, P = 0.0002), and an absolute 12%less likelihood of receiving adjuvant radiotherapy (P = 0.04). Local and distant failures were not significantly different. Overall survival favored GYN patients (P = 0.02) with no difference in disease-specific survival (P = 0.38). Multivariate analysis for disease-free survival revealed HIR disease (P = 0.04) and GYO treatment (P = 0.049) to be significant, with a trend for age ≤64 (P = 0.05). Multivariate analysis for overall survival found age ≤64 (P = 0.0001), HIR disease (P = 0.01), and adjuvant radiotherapy (P = 0.0055) to be significant. Conclusions. Women primarily managed by a GYO for early-stage disease were significantly less likely to receive adjuvant radiotherapy. Despite significantly more unfavorable disease characteristics among GYO-managed women,disease-free and cause-specific survival were equivalent between the two groups. Favorable disease characteristics and adjuvant radiotherapy correlated with improved survival on multivariate analysis.展开更多
Background: Current guidelines for the surgical management of melanoma aim to bring a combined consensus approach to the surgery of melanoma. Whether differe nt outcomes for melanoma are related to the specialist who ...Background: Current guidelines for the surgical management of melanoma aim to bring a combined consensus approach to the surgery of melanoma. Whether differe nt outcomes for melanoma are related to the specialist who treats the patient is unknown. Objectives: To examine the clinicopathological features and surgical m anagement of patients with primary cutaneous malignant melanoma treated by derma tologists,general surgeons, plastic surgeons and general practitioners (GPs). We also examined if the category of specialist had an effect on the survival outco me for the patient. Methods: A retrospective, observational study of patients re gistered on a specialist database that records the clinicopathological features, surgical treatment and follow-up information of patients with malignant melan oma in Scotland. The patients had invasive primary cutaneous malignant melanoma without evidence of metastasis at the time of surgery, diagnosed between 1979 an d 1997, with follow-up to the end of December 1999. Clinicopathological charac teristics and surgical treatment of patientswere compared for the four groups of specialist, as were overall survival (OS), disease-free survival (DFS) and re currence-free interval (RF). Results: Of 1536 patients, 663 (43% ) were treat ed initially by a dermatologist, 486 (32% ) by a general surgeon, 257 (17% ) b y a plastic surgeon and 130 (8% ) by a GP. The proportion of patients managed b y dermatologists rose over the lifetime of the study. Compared with the other sp ecialists, the patients treated by general and plastic surgeons were older; a hi gher proportion of female patients was managed by dermatologists; median tumour thickness, lesion diameter and frequency of ulceration were all greater in the g eneral surgeon-treated group; plastic surgeons treated a higher proportion of lentigo maligna melanomas; and general surgeons and GPs saw a higher proportion of nodular melanomas. Over 90% of patients managed by a dermatologist or GP un derwent wider local excision following initial excision, compared with 43% and 25% , respectively, in the general and plastic surgery groups. General surgeon s used wider excision margins than the other specialists. OS, DFS and RF were si gnificantly better in the dermatology group comparedwith the general and plastic surgery groups. Conclusions: This study showed that dermatologists manage an in creasing majority of melanoma patients and that there were significant differenc es in the surgical treatment of melanoma between dermatologists and surgeons. Su rvival was significantly better in the dermatology-treated group, suggesting t hat dermatologists should have a central role in melanoma management.展开更多
文摘Objective. To evaluate treatment outcomes in women with early-stage endometrial cancer (FIGO IA, IB, IC, or IIA)-surgically managed by a general gynecologist (GYN) or a gynecologic oncologist (GYO). Methods and results. 349 women treated from 1990-2003 were studied. Median follow-up was 3.7 years. Ninety-five were classified as highintermediate risk (HIR: stages IB grade III, IC grade II or III, any stage IIA). 110 women received adjuvant radiotherapy. The GYO group had more unfavorable tumor characteristics based on stage and grade (P < 0.0001), shorter follow-up (median 3.1 vs. 5.1 years, P = 0.0002), and an absolute 12%less likelihood of receiving adjuvant radiotherapy (P = 0.04). Local and distant failures were not significantly different. Overall survival favored GYN patients (P = 0.02) with no difference in disease-specific survival (P = 0.38). Multivariate analysis for disease-free survival revealed HIR disease (P = 0.04) and GYO treatment (P = 0.049) to be significant, with a trend for age ≤64 (P = 0.05). Multivariate analysis for overall survival found age ≤64 (P = 0.0001), HIR disease (P = 0.01), and adjuvant radiotherapy (P = 0.0055) to be significant. Conclusions. Women primarily managed by a GYO for early-stage disease were significantly less likely to receive adjuvant radiotherapy. Despite significantly more unfavorable disease characteristics among GYO-managed women,disease-free and cause-specific survival were equivalent between the two groups. Favorable disease characteristics and adjuvant radiotherapy correlated with improved survival on multivariate analysis.
文摘Background: Current guidelines for the surgical management of melanoma aim to bring a combined consensus approach to the surgery of melanoma. Whether differe nt outcomes for melanoma are related to the specialist who treats the patient is unknown. Objectives: To examine the clinicopathological features and surgical m anagement of patients with primary cutaneous malignant melanoma treated by derma tologists,general surgeons, plastic surgeons and general practitioners (GPs). We also examined if the category of specialist had an effect on the survival outco me for the patient. Methods: A retrospective, observational study of patients re gistered on a specialist database that records the clinicopathological features, surgical treatment and follow-up information of patients with malignant melan oma in Scotland. The patients had invasive primary cutaneous malignant melanoma without evidence of metastasis at the time of surgery, diagnosed between 1979 an d 1997, with follow-up to the end of December 1999. Clinicopathological charac teristics and surgical treatment of patientswere compared for the four groups of specialist, as were overall survival (OS), disease-free survival (DFS) and re currence-free interval (RF). Results: Of 1536 patients, 663 (43% ) were treat ed initially by a dermatologist, 486 (32% ) by a general surgeon, 257 (17% ) b y a plastic surgeon and 130 (8% ) by a GP. The proportion of patients managed b y dermatologists rose over the lifetime of the study. Compared with the other sp ecialists, the patients treated by general and plastic surgeons were older; a hi gher proportion of female patients was managed by dermatologists; median tumour thickness, lesion diameter and frequency of ulceration were all greater in the g eneral surgeon-treated group; plastic surgeons treated a higher proportion of lentigo maligna melanomas; and general surgeons and GPs saw a higher proportion of nodular melanomas. Over 90% of patients managed by a dermatologist or GP un derwent wider local excision following initial excision, compared with 43% and 25% , respectively, in the general and plastic surgery groups. General surgeon s used wider excision margins than the other specialists. OS, DFS and RF were si gnificantly better in the dermatology group comparedwith the general and plastic surgery groups. Conclusions: This study showed that dermatologists manage an in creasing majority of melanoma patients and that there were significant differenc es in the surgical treatment of melanoma between dermatologists and surgeons. Su rvival was significantly better in the dermatology-treated group, suggesting t hat dermatologists should have a central role in melanoma management.
