Quality of surgery and treatment and its association with hospital volume: A population-based study in more than 5000 Belgian ovarian cancer patients

The landscape of ovarian cancer surgery in Italy: Data from PNE

Objective

Ovarian cancer (OC) in Italy is tenth in incidence among tumors in females, and it is the cause of 30 % of deaths due to gynecological tumors. The objective of this study is to evaluate the volume of patients undergoing surgical treatment for OC in Italian hospital facilities.

Methods

An analysis of hospitalization volumes due to OC in Italian medical facilities in 2022 based on the Piano Nazionale Esiti was performed. Centers were divided into 3 categories, according to the annual number of hospitalizations due to OC (above 30, between 20 and 29, below 20); the percentage of patients treated in each category of hospitals was calculated. Additionally, an evaluation of the active mobility (meaning the number of patients living outside the region but receiving treatment in the region taken into examination) and passive mobility (meaning the number of patients living inside the examined region but choosing to receive treatment in centers located outside of the region itself) was carried out for each region.

Results

The study showed that, in 11 Italian regions, most of OC cases are treated in medical centers with patient volumes of less than 20 cases per year. Only in 6 regions, OC cases are mostly treated in larger centers; in these same regions, the highest percentages of active mobility are recorded. Finally, in 6 Italian regions, passive mobility exceeds 50 % of regional cases.

Conclusions

Nowadays, the landscape of OC treatment in Italy is extremely heterogeneous. In most regions, patients receive treatment in low volume centers; concurrently, huge volumes of patients hailing from the entire national territory are treated in a limited number of centers.

Impact of lymphadenectomy rates in the quality assurance program in early ovarian cancer of the AGO Study Group - Real-world observations

OBJECTIVES

The German quality assurance program (QS-Ovar) representatively documents treatment and survival for patients with the initial diagnosis of primary ovarian cancer in the third quarters of 2004, 2008, 2012, 2016, and 2021. We evaluate lymphadenectomy (LNE) rates in dependence on histologic subtype and outcome for early ovarian cancer FIGO I.

METHODS

Therapy quality was defined according to national guidelines. Surgical quality was categorized as "optimal" (SUR+: maximum 1 surgical item missing), versus "suboptimal" (SUR-); analogous categorization "optimal" systemic treatment (CT+) and "suboptimal" (CT-).

RESULTS

Overall, 832 pts. (19.3 %) were diagnosed with FIGO I, of them 47.6 % with FIGO IC, 35.7 % had a high-grade serous subtype, 5.0 % low-grade serous, 6.9 % low-grade endometrioid, 18 % high-grade endometrioid, 11 % clear cell, and 18 % mucinous tumors. The optimal surgical standard increased from 21.1 % (2004) to 53.0 % (2012). Surgical quality has remained unchanged in 2021 with 53.8 % and SUR + -subgroup with 74.2 %. The rate of pelvic and para-aortic lymphadenectomy increased over time for high-grade serous and clear cell carcinoma and decreased for mucinous carcinoma. In 2021, 67.6 % had ≥25 resected lymph-nodes in high-grade serous, 46.2 % in low-grade serous, 52.2 % in high-grade endometrioid, 35.3 % in low-grade endometrioid, 74.1 % in clear cell and 35.7 % in mucinous tumors. In 2021, the SUR+/CT + -subgroup decreased to 62.9 % versus 69.2 % in 2016. Four-year-disease-free-survival was 86 % for SUR+/CT+, 78 % for SUR-/CT+, 68 % for SUR+/CT- and 57 % for SUR-/CT- (p < 0.001).

CONCLUSIONS

One therapy modality cannot replace another one. Although urgently required, quality of therapy has not improved in 2021.