Specialist gynaecologists and survival outcome in ovarian cancer: a Scottish national study of 1866 patients

Objective To determine whether specialist gynaecological surgeons improved survival in women with ovarian cancer when compared with general gynaecologists. Design Retrospective case note review. Population All women diagnosed with ovarian cancer in Scotland in 1987, 1992, 1993 and 1994. Methods Data on prognostic factors and surgical and post-operative management was extracted from case notes. Surgeons were classified as specialist gynaecologists, general gynaecologists or general surgeons by an independent committee with no knowledge of an individual's outcome. Cox's proportional hazards model was used to determine the relative risk of a patient dying, if managed by specialist and general gynaecologists, after adjustment for age, histology, tumour differentiation, presence of ascites and socio-economic status. Analysis was performed separately for each FIGO stage. Main outcome measures Relative hazard ratios for survival up to three years. Results Survival benefit for specialists varied according to the stage of the disease. The greatest benefit was observed among women with Stage III disease (44% of women presented at this stage) where there was a 25% (relative hazard ratio = 0.75, P = 0.005) reduction in the rate of dying for women operated on by specialist gynaecologists, compared with women operated on by general gynaecologists. Differential use of platinum chemotherapy did not explain this survival advantage. Specialist gynaecologists more often debulked tumour to <2 cm than general gynaecologists in Stage III cases (36.3% vs 28.7%, P = 0.07). In women with Stage III carcinoma with >2 cm remaining, survival was significantly improved for women treated by specialist gynaecologists (relative hazard ratio = 0.71, P = 0.007). No significant differences were observed for patients with Stages I, II and IV disease, although there were fewer deaths in women with early stage disease. Conclusions Specialist gynaecologists improve survival for some women with ovarian cancer.