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      Adherence to French and ESGO Quality Indicators in Ovarian Cancer Surgery: An Ad-Hoc Analysis from the Prospective Multicentric CURSOC Study

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          French and European Quality Indicators have been developed for the management of ovarian cancer. In this study, we aimed to assess the ovarian cancer care distribution in France according to the volume of patients treated per hospital, and to evaluate the adherence of different centers to the quality indicators. We found that the majority of ovarian cancer patients were treated in hospitals that did not reach recommended cut-off values in terms of volume, and it is known that surgical care in low-volume hospitals is associated with worse outcome. Only 44% of high-volume centers met all the quality indicator criteria. Therefore, access to high-volume ovarian cancer providers accomplishing all the recommended institutional quality indicators is restricted to a minority of patients in France. It is mandatory that national authorities work both to improve the centralization of ovarian cancer management and to incorporate quality assurance programs into certified centers.

          Abstract

          Background: Quality Indicators for ovarian cancer (OC) have been developed by the European Society of Gynaecological Oncology (ESGO) and by the French National Cancer Institute (Institut National du Cancer, INCa). The aim of the study was to characterize OC care distribution in France by case-volume and to prospectively evaluate the adherence of high-volume institutions to INCa/ESGO quality indicators. Methods: The cost-utility of radical surgery in ovarian cancer (CURSOC) trial is a prospective, multicenter, comparative and non-randomized study that includes patients with stage IIIC-IV epithelial OC treated in nine French health care tertiary institutions. Adherence to institutional quality indicators were anonymously assessed by an independent committee. OC care distribution in France were provided by the nationwide database of hospital procedures. Results: More than half of patients are treated in low-volume institutions. Among the nine high-volume centers participating in the study, four (44.4%) met all institutional INCa/ESGO quality indicators. The other five (55.6%) did not fulfil one of the quality indicator criteria. Conclusions: Access to high-volume OC providers in France is restricted to a minority of patients, and yet half of the referral institutions included in this study failed to meet all recommended institutional quality indicators. It is mandatory that national authorities work both to improve OC centralization and to incorporate quality assurance programs into certified centers.

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          Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis.

          Robert E. Bristow, Rafael S Tomacruz, Deborah Armstrong … (2002)
          To evaluate the relative effect of percent maximal cytoreductive surgery and other prognostic variables on survival among cohorts of patients with advanced-stage ovarian carcinoma treated with platinum-based chemotherapy. Eighty-one cohorts of patients with stage III or IV ovarian carcinoma (6,885 patients) were identified from articles in MEDLINE (1989 through 1998). Linear regression models, with weighted correlation calculations, were used to assess the effects on log median survival time of the proportion of each cohort undergoing maximal cytoreduction, dose-intensity of the platinum compound administered, proportion of patients with stage IV disease, median age, and year of publication. There was a statistically significant positive correlation between percent maximal cytoreduction and log median survival time, and this correlation remained significant after controlling for all other variables (P <.001). Each 10% increase in maximal cytoreduction was associated with a 5.5% increase in median survival time. When actuarial survival was estimated, cohorts with < or = 25% maximal cytoreduction had a mean weighted median survival time of 22.7 months, whereas cohorts with more than 75% maximal cytoreduction had a mean weighted median survival time of 33.9 months--an increase of 50%. The relationship between platinum dose-intensity and log median survival time was not statistically significant. During the platinum era, maximal cytoreduction was one of the most powerful determinants of cohort survival among patients with stage III or IV ovarian carcinoma. Consistent referral of patients with apparent advanced ovarian cancer to expert centers for primary surgery may be the best means currently available for improving overall survival.
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            High-volume ovarian cancer care: survival impact and disparities in access for advanced-stage disease.

            E Bristow, Argyrios Ziogas, Katrina L. Randall … (2014)
            To characterize the impact of hospital and physician ovarian cancer case volume on survival for advanced-stage disease and investigate socio-demographic variables associated with access to high-volume providers. Consecutive patients with stage IIIC/IV epithelial ovarian cancer (1/1/96-12/31/06) were identified from the California Cancer Registry. Disease-specific survival analysis was performed using Cox-proportional hazards model. Multivariate logistic regression analyses were used to evaluate for differences in access to high-volume hospitals (HVH) (≥20 cases/year), high-volume physicians (HVP) (≥10 cases/year), and cross-tabulations of high- or low-volume hospital (LVH) and physician (LVP) according to socio-demographic variables. A total of 11,865 patients were identified. The median ovarian cancer-specific survival for all patients was 28.2 months, and on multivariate analysis the HVH/HVP provider combination (HR = 1.00) was associated with superior ovarian cancer-specific survival compared to LVH/LVP (HR = 1.31, 95%CI = 1.16-1.49). Overall, 2119 patients (17.9%) were cared for at HVHs, and 1791 patients (15.1%) were treated by HVPs. Only 4.3% of patients received care from HVH/HVP, while 53.1% of patients were treated by LVH/LVP. Both race and socio-demographic characteristics were independently associated with an increased likelihood of being cared for by the LVH/LVP combination and included: Hispanic race (OR = 1.72, 95%CI = 1.22-2.42), Asian/Pacific Islander race (OR = 1.57, 95%CI = 1.07-2.32), Medicaid insurance (OR = 2.51, 95%CI = 1.46-4.30), and low socioeconomic status (OR = 2.84, 95%CI = 1.90-4.23). Among patients with advanced-stage ovarian cancer, the provider combination of HVH/HVP is an independent predictor of improved disease-specific survival. Access to high-volume ovarian cancer providers is limited, and barriers are more pronounced for patients with low socioeconomic status, Medicaid insurance, and racial minorities. Copyright © 2013 Elsevier Inc. All rights reserved.
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              Randomized phase III study to evaluate the impact of secondary cytoreductive surgery in recurrent ovarian cancer: Final analysis of AGO DESKTOP III/ENGOT-ov20.

              Andreas du Bois, Jalid Sehouli, Ignace Vergote … (2020)
              6000 Background: The role of secondary cytoreductive surgery in recurrent ovarian cancer (ROC) has been under debate for decades. A recent trial in unselected patients (pts) failed to show an OS benefit. Methods: Pts with ROC and 1st relapse after 6+ months (mos) platinum-free interval (TFIp) were eligible if they presented with a positive AGO-score (PS ECOG 0, ascites ≤500 ml, and complete resection at initial surgery) and were prospectively randomized to second-line chemotherapy alone vs. cytoreductive surgery followed by the same chemotherapy; platinum combination therapy was recommended. OS was primary endpoint in this superiority trial. Results: 407pts were randomized 2010-2014. The TFIp exceeded 12 mos in 75% of pts. 206 pts were allocated to the surgery arm of whom finally 187 (91%) were operated. A complete resection was achieved in 75%; almost 90% in both arms received a platinum-containing second-line chemo. Primary endpoint analysis showed median OS of 53.7 mos with and 46.2 mos without surgery (HR 0.76, 95%CI 0.59-0.97, p=0.03); median PFS was 18.4 and 14 mos (HR: 0.66, 95%CI 0.54-0.82, p<0.001), median time to start of first subsequent therapy (TFST) was 17.9 vs. 13.7 mos in favor of the surgery arm (HR 0.65, 95%CI 0.52-0.81, p<0.001). An analysis according to treatment showed an OS benefit exceeding 12 mos for pts with complete resection (CR) compared to pts without surgery (median 60.7 vs. 46.2 mos); pts with surgery and incomplete resection even did worse (median 28.8 mos). 60 d mortality rates were 0 and 0.5% in the surgery and no-surgery arm. Re-laparotomies were performed in 3.7% of operated pts. Further grade 3/4 adverse events did not differ significantly between arms. Conclusions: This is the first surgical study demonstrating a meaningful survival benefit in OC: Surgery in pts with first relapse and TFIp of 6+ mos and selected by a positive AGO-Score resulted in a significant increase of OS, PFS and TFST with acceptable morbidity and, therefore, should be offered to suitable pts. The benefit was exclusively seen in pts with CR indicating the importance of both the optimal selection of pts (eg. by AGO score) and of centres with expertise and a high chance of achieving a CR. Clinical trial information: NCT01166737.
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                Author and article information

                Contributors
                Noriomi Matsumura: Role: Academic Editor
                Gennaro Cormio: Role: Academic Editor
                Journal
                Journal ID (nlm-ta): Cancers (Basel)
                Journal ID (iso-abbrev): Cancers (Basel)
                Journal ID (publisher-id): cancers
                Title: Cancers
                Publisher: MDPI
                ISSN (Electronic): 2072-6694
                Publication date (Electronic): 30 March 2021
                Publication date Collection: April 2021
                Volume: 13
                Issue: 7
                Electronic Location Identifier: 1593
                Affiliations
                [1 ]Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer—Toulouse Oncopole, 59500 Toulouse, France; ferron.gwenael@ 123456iuct-oncopole.fr (G.F.); AngelesFite.Martina@ 123456iuct-oncopole.fr (M.A.A.)
                [2 ]Cancer Research Center of Toulouse (CRCT), INSERM UMR 1037, 31037 Toulouse, France
                [3 ]Obstetrics and Gynecology Department, University Hospital Lyon Sud, 69008 Lyon, France; witold.gertych@ 123456chu-lyon.fr (W.G.); francois.golfier@ 123456chu-lyon.fr (F.G.)
                [4 ]Surgical Oncology Department, Centre Jean Perrin, 63000 Clermont Ferrand, France; cristophe.pomel@ 123456cjp.fr
                [5 ]Biostatistics Department, Institut Claudius Regaud, Institut Universitaire du Cancer—Toulouse Oncopole, 59500 Toulouse, France; lusque.amelie@ 123456iuct-oncopole.fr
                [6 ]Surgical Oncology Department, Institut Paoli Calmettes, 13009 Marseille, France; lambaudiee@ 123456ipc.unicancer.fr
                [7 ]Surgical Oncology Department, Institut Curie, 75248 Paris, France; roman.rouzier@ 123456curie.fr (R.R.); nicolas.pouget@ 123456curie.fr (N.P.)
                [8 ]Visceral and Digestive Surgery, University Hospital of Lyon Sud, 69008 Lyon, France; naoual.bakrin@ 123456chu-lyon.fr (N.B.); olivier.glehen@ 123456chu-lyon.fr (O.G.)
                [9 ]Obstetrics and Gynecology, University Hospital Clermont Ferrand, 63000 Clermont Ferrand, France; mcanis@ 123456chu-clermontferrand.fr (M.C.); nbourdel@ 123456chu-clermontferrand.fr (N.B.)
                [10 ]Surgical Oncology, Institut du Cancer Montpellier, 34090 Montpellier, France; Pierre-Emmanuel.Colombo@ 123456icm.unicancer.fr
                [11 ]Surgical Oncology, Institut Bergonié, 33000 Bordeaux, France; f.guyon@ 123456bordeaux.unicancer.fr
                [12 ]1203, rue des Glacis, 59500 Douai, France; jacques.meurette@ 123456assurance-maladie.fr
                [13 ]Department of Gynecologic Oncology, Agostino Gemelli University Hospital, 00168 Rome, Italy; denis.querleu@ 123456esgo.org
                [14 ]Department of Obstetrics and Gynecology, University Hospital of Strasbourg, 67091 Strasbourg, France
                Author notes
                Author information
                https://orcid.org/0000-0003-1233-5003
                https://orcid.org/0000-0003-4634-6712
                https://orcid.org/0000-0002-2802-4974
                https://orcid.org/0000-0002-5527-4370
                Article
                Publisher ID: cancers-13-01593
                DOI: 10.3390/cancers13071593
                PMC ID: 8037412
                PubMed ID: 33808284
                SO-VID: 1897ba37-c159-448c-b6b1-01d17bad8137
                Copyright © © 2021 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 18 February 2021
                Date accepted : 25 March 2021
                Categories
                Subject: Article

                Keywords: quality indicators,ovarian cancer,surgery,france
                Data availability:
                Keywords: quality indicators, ovarian cancer, surgery, france

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