RESUMEN
The aim of this study was to evaluate the prognostic impact of hemoglobin (Hb) levels before and throughout the course of platinum-based chemotherapy in patients with primary epithelial ovarian cancer (EOC). Medical records of patients who had undergone initial surgery followed by platinum-based chemotherapy for EOC were retrospectively studied. Univariate and Cox-regression models were used to evaluate the prognostic impact of various factors including Hb levels before and throughout chemotherapy in terms of overall survival. Additionally, sensitivity/specificity were calculated using receiver operating curves (ROCs) and Kaplan-Meier studies were used to determine optimal cut-off levels. The median duration of follow-up was 37.0 months. Degree of anemia before starting chemotherapy was significantly related to overall survival (p = 0.001), but the Hb level throughout chemotherapy demonstrated only a borderline relationship (p = 0.062). Only residual tumor after surgery and degree of anemia before starting chemotherapy proved to be independent prognostic factors (p = 0.013 and 0.015, respectively). With sensitivity/specificity and Kaplan-Meier analyses, a Hb level before starting chemotherapy of less than 10.5 g/dl was related to shorter overall survival (p = 0.002). In conclusion, pre-chemotherapy Hb level has a prognostic impact on overall survival in patients with EOC candidate to first-line platinum-based chemotherapy. However, the significance of decreased Hb levels during chemotherapy needs to be clarified in further prospective studies to determine optimal Hb levels for achieving a favorable outcome.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Hemoglobinas/metabolismo , Neoplasias Glandulares y Epiteliales/sangre , Neoplasias Glandulares y Epiteliales/tratamiento farmacológico , Neoplasias Ováricas/sangre , Neoplasias Ováricas/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carcinoma Epitelial de Ovario , Quimioterapia Adyuvante/efectos adversos , Quimioterapia Adyuvante/métodos , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias/métodos , Neoplasias Glandulares y Epiteliales/cirugía , Compuestos Organoplatinos/administración & dosificación , Neoplasias Ováricas/cirugía , Pronóstico , Modelos de Riesgos Proporcionales , Análisis de Regresión , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To assess the effect of an audit and feedback intervention on the accuracy of the diagnosis summary in the medical records of gynecologic patients in Songklanagarind Hospital. MATERIAL AND METHOD: An audit was conducted on the medical records of 468 gynecologic patients that visited between January 2006 and March 2007. They were divided into non-malignant and malignant conditions both before and after the planned intervention. RESULTS: The accuracy of the summary of the diagnosis for non-malignant conditions was better than malignant conditions. The correction to the principle diagnosis in medical records of patients with malignant conditions increased significantly from 16.7% to 42.9% (p < 0.001) after the audit and feedback. In medical records of non-malignant conditions, corrections to the principle diagnosis and any complications also significantly increased from 72.0% to 82.0% (p = 0.01) and 76.0% to 90.7% (p = 0.002), respectively. CONCLUSION: Audit and feedback is effective for improving the accuracy of the diagnosis summary for gynecological conditions but malignant conditions need more improvement strategies.