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Il carcinoma ovarico in Italia
Prof.ssa Nicoletta ColomboUniversita’ Milano Bicocca
Direttore Divisione Ginecologia Oncologica Medica Istituto Europeo Oncologia, Milano
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• 204.000 casi/anno (4,0% dei tumori nelle donne)
• 125.000 decessi/anno (4,2% dei decessi per cancro nelle donne)
Incidenza e mortalità per carcinoma
(Tassi standardizzati per età/100.000)
20 10 0 10 20
1.8
1.5
2.3
2.6
3.2
3.2
3.8
3.4
4.1
3.5
3.9
4.0
3.6
4.1
3.7
5.1
4.5
6.0
6.1
6.3
7.9
2.6
3.2
3.3
4.3
4.6
5.2
5.3
5.3
5.8
6.4
6.6
6.8
7.2
7.2
7.7
9.4
9.7
10.2
10.7
11.3
13.3
Incidence MortalityNorthern Europe
Western Europe
Northen America
Eastern Europe
Southern Europe
Australia/New Zealand
South America
South-Eastern Asia
Central America
Micro/Polynesia
Melanesia
Japan
Eastern Africa
Western Asia
South Central Asia
Southern Africa
Western Africa
Caribbean
Middle Africa
China
Northern Africa
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Quale e’ il significato del carcinoma ovarico in Europa ed in Italia ?
Incidence65697
Mortality44280
Incidence5114
Mortality3087
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I numeri del Cancro 2012AIOM-AIRTUM
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Come possiamo migliorare ?
Quali sono i determinanti della prognosi?
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Hospital and Physician Volume and Cancer Treatment Outcomes
Hillner et al. J Clin Oncol 2000; 18: 2327.
• Cancer site-specific
positive volume-outcome effects for:
Lung Prostate
Breast Lymphoma
Pancreas Ovary
Colorectal
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OS of stage III OC according to specialty of surgeon performing initial surgery
Junour et al., 1999
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P< .001
Impact of a Specialization
Chan J et al. Obstet Gynecol 2007; 109:1342-50.
Refer patients to specialized center
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13
Norway
4.58
Tropé-Kolstad meeting 2011
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Paulsen er al. Int J Gynecol Cancer 2006, 16 (Suppl. 1), 11–17
Survival according to specialty
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Survival by type of hospital
Paulsen er al. Int J Gynecol Cancer 2006, 16 (Suppl. 1), 11–17
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Number of operations per physician
>10 operations
1-10 operations
0
.2
.4
.6
.8
1C
umul
ativ
e S
urvi
val
0 200 400 600 800 1000Survival in days
Tropé-Kolstad meeting 2011
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Consequences of the Norwegian study
• This study strongly contributed to the policy makers’ decision to centralize EOC surgery in Norway.
• In 2005 a national consensus for centralization of advanced EOC to the teaching hospital was recommended (health minister Brustad).
• Tromsø, Trondheim, Bergen, and Oslo• Also Sweden, Denmark, and Finland have decided to
centralize ovarian cancer surgery• Sweden 7, Denmark 5, and Finland 5 centers
Tropé-Kolstad meeting 2011
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RIDUZIONE DEL 12% DI MORTALITÀ PER TUMORI GINECOLOGICI IN CENTRI SPECIALIZZATI
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CONCLUSIONI
• Le donne con tumori ginecologici che ricevono il trattamento in centri specializzati hanno una sopravvivenza più lunga rispetto alle paziente trattate in centri non specializzati.
• Questa evidenza è maggiore per il tumore dell’ovaio rispetto agli altri tumori ginecologici.
• C’è bisogno di ulteriori studi che devono inoltre valutare la qualità di vita associata alla centralizzazione delle pazienti affette da tumori ginecologici.
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Opening –Ovarian Cancer Center IEO
24 Settembre 2008
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..formare un “team” per il trattamento del carcinoma ovarico
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PathologistPathologistPsicooncologistPsicooncologist
Abdominal and thoracic surgeon
Abdominal and thoracic surgeon
GenetistGenetist
RadiologistRadiologistSupportSupport
AnesthesiologistAnesthesiologistGynecologic OncologistGynecologic Oncologist
Multidisciplinarity
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Paziente
Chirurgo Generale
Genetista
garantire un approccio olistico alla Persona
.Ginecologo Oncologo
Oncologo medico
Psico-Oncologo
Supporto
Anestesista
Radiologo
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Il carcinoma ovarico rimane la principale causa di morte per neoplasie ginecologiche nei paesi sviluppati
In tutti gli studi , il beneficio assoluto legato alla presa in carico da parte di strutture con elevato volume eccede il beneficio dei trattamenti piu’ innovativi
Numerosi studi suggeriscono che il trattamento del carcinoma ovarico da parte di ginecologi oncologi in centri specializzati si traduce in un miglioramento della prognosi e dell’outcome economico.
Conclusioni
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……..Il quarto impegno è volto a istituire dei Centri regionali di riferimento per la diagnosi e la cura del carcinoma ovarico, che fungano da primi interlocutori delle pazienti. È per questo che chiediamo un piano oncologico nazionale.
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