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abstract:
Centralized primary care of advanced ovarian cancer improves complete cytoreduction and survival - A population-based cohort study
June 11, 2016
Highlights
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- Centralized primary surgery of advanced ovarian cancer increases complete cytoreduction
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- Centralized advanced ovarian cancer care shortens time interval from surgery to chemotherapy
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- Survival improves significantly when primary care of advanced ovarian cancer is centralized
Objective
To
evaluate centralized primary care of advanced ovarian and fallopian
tube cancers in a complete population cohort in relation to complete
cytoreduction, time interval from surgery to chemotherapy and relative
survival.
Methods
A regional
population-based cohort study of women diagnosed with primary ovarian
and fallopian tube cancers and included in the Swedish Quality Registry
(SQR) during 2008–2013 in a region where primary care of advanced stages
was centralized in 2011. Surgical, oncological characteristics,
outcomes, follow-ups and relative survivals were analyzed.
Results
There
were 817 women diagnosed with ovarian and fallopian tube cancers during
2008–2013 and 523 were classified as FIGO stage III-IV and further
analyzed. Primary debulking surgery (PDS) was performed in 81% and
neoadjuvant chemotherapy (NACT) followed by interval debulking surgery
(IDS) in 11%. Complete cytoreduction at PDS was performed in 37% before
compared to 49% after centralization (p < 0.03). The
chemotherapy protocols were identical in the cohorts and they received
and completed the planned chemotherapy equally. The time interval
between PDS and chemotherapy was 36 days (median) before compared to
24 days after centralization (p < 0.01). The relative 3-year
survival rate in women treated by PDS was 44% compared to 65% after
centralization and the estimated excess mortality rate ratio (EMRR) was
reduced (RR 0.58; 95% CI 0.42–0.79). Comparing the complete cohorts
before and after centralization, regardless primary treatment, the
relative 3-year survival rate increased from 40% to 61% with reduced
EMRR (RR 0.59; 95% CI 0.45–0.76).
Conclusion
Centralized
primary care of advanced ovarian and fallopian tube cancers increases
complete cytoreduction, decreases time interval from PDS to chemotherapy
and improves relative survival significantly.
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