abstract
OBJECTIVES:
Objectives
of this study were to evaluate the effect of changes in patterns of
care, for example
centralization and treatment sequence, on surgical
outcome and survival in patients with epithelial ovarian cancer (EOC).
METHODS:
Patients
diagnosed with FIGO stage IIB-IV EOC (2004-2013) were selected from the
Netherlands Cancer Registry. Primary outcomes were surgical outcome
(extent of macroscopic residual tumor after surgery) and overall
survival. Changes in treatment sequence (primary debulking surgery and
adjuvant chemotherapy (PDS+ACT) or neoadjuvant chemotherapy and interval
debulking surgery (NACT+IDS)), hospital type and annual hospital volume
were also evaluated.
RESULTS:
Patient
and tumor characteristics of
7987 patients were retrieved. Most
patients were diagnosed with stage III-IV EOC. The average annual
case-load per hospital increased from 8 to 28. More patients received an
optimal cytoreduction (tumor residue ≤1cm) in 2013 (87%) compared to
2004 (55%, p<0.001). Complete cytoreduction (no macroscopic residual
tumor), registered since 2010, increased from 42% to 52% (2010 and 2013,
respectively, p<0.001). Optimal/complete cytoreduction was achieved
in 85% in high volume (≥20 cytoreductive surgeries annually), 80% in
medium (10-19 surgeries) and 71% in small hospitals (<10 surgeries,
p<0.001). Within a selection of patients with advanced stage disease
that underwent surgery the proportion of patients undergoing NACT+IDS
increased from 28% (2004) to 71% (2013).
Between 2004 and 2013 a 3%
annual reduction in risk of death was observed (HR 0.97, p<0.001).
CONCLUSION:
Changes in pattern of care for patients with EOC in the Netherlands have led to improvement in surgical outcome and survival.
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