Abstract
BackgroundTo investigate the relationship between hospital volume activities and the survival for Epithelial Ovarian Carcinoma (EOC) patients in France.MethodsThis retrospective study using prospectively implemented databases was conducted on an exhaustive cohort of 267 patients undergoing first-line therapy during 2012 in the Rhone-Alpes Region of France. We compared Progression-Free Survival for Epithelial Ovarian Carcinoma patients receiving first-line therapy in high- (i.e. ≥ 12 cases/year) vs. low-volume hospitals. To control for selection bias, multivariate analysis and propensity scores were used. An adjusted Kaplan-Meier estimator and a univariate Cox model weighted by the propensity score were applied.ResultsPatients treated in the low-volume hospitals had a probability of relapse (including death) that was almost two times (i.e. 1.94) higher than for patients treated in the high-volume hospitals (p < 0.001).ConclusionTo our knowledge, this is the first study conducted in this setting in France. As reported in other countries, there was a significant positive association between greater volume of hospital care for EOC and patient survival. Other factors may also be important such as the quality of the surgical resection.
Highlights
To investigate the relationship between hospital volume activities and the survival for Epithelial Ovarian Carcinoma (EOC) patients in France
To determine whether the Progression-Free Survival (PFS) was longer in high-volume hospitals (HVH), we needed to define a threshold based on the volume of activity of hospitals in the study
The upper quartile was chosen as the cut-off value for HVH where 25% of EOC patients in first-line treatment during the year 2012 are categorized as being treated in HVH versus 75% as being treated in Low-Volume Hospitals (LVH)
Summary
To investigate the relationship between hospital volume activities and the survival for Epithelial Ovarian Carcinoma (EOC) patients in France. While epithelial ovarian carcinoma (EOC) is known to be a serious disease, its impact is often underestimated due to its relatively low incidence and its high mortality rate. EOC remains the main cause of gynecological cancer deaths in industrialized countries, with a mortality rate in France of about 4/100000 persons per year [1]. Relapse-free survival and overall survival of patients are related to the characteristics of the disease, the patient herself, and the disease management. The latter is based on surgery with a complete tumor resection, which can have a significant impact even on stage IV disease. A higher quality of surgery when performed by gynecological oncologists in specialized hospitals (i.e. referral centers) and only small differences
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