Efficacy of a regional network for ovarian cancer care.
| Autor: | van Altena AM; Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, the Netherlands. A.vanAltena@obgyn.umcn.nl, van den Akker PA, de Hullu JA, Ottevanger PB, Aalders AL, Gerritse R, Happel M, Hoekstra MP, Janssen MJ, Samlal RA, Smeets KM, Snijders MP, Vasmel MJ, Vollebergh JH, Kiemeney LA, Massuger LF |
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| Jazyk: | angličtina |
| Zdroj: | Obstetrics and gynecology [Obstet Gynecol] 2013 Sep; Vol. 122 (3), pp. 668-75. |
| DOI: | 10.1097/AOG.0b013e3182a054ee |
| Abstrakt: | Objective: To study the influence of a regional collaboration in epithelial ovarian cancer care on staging procedures, debulking results, and survival. Methods: In an effort to optimize epithelial ovarian cancer treatment, a regional collaboration was introduced in the Netherlands in 2000. Gynecologic oncologists from the university center conducted surgery in community hospitals when ovarian cancer was considered based on the risk of malignancy index or clinical suspicion. The National Cancer Registry registered 1,554 patients with epithelial ovarian cancer diagnosed in 11 participating Dutch hospitals between 1996 and 2010. Surgical procedures were compared during three periods (1996-1999, 2000-2004, and 2005-2009). Log-rank tests compared Kaplan-Meier survival curves of progression-free and overall survival before (1996-2000) and during the start of the collaboration (2001-2005). Results: Staging was adequate for 139 patients (23.0%) before collaboration, and this proportion increased during the study periods to 32.1% and 62.1% (P<.01), when gynecologic oncologists more often staged cancer in patients (36.7% compared with 54.7% and 80.6%; P<.01). For 1,197 patients with advanced stage disease (stage IIb or greater), the proportion of debulking procedures with an optimal (residual volume less than1 cm) as well as a complete result (no residuals) increased during the 14-year study period from 57.4% to 76.5% (P<.01) and from 24.1% to 43.4% (P<.01), respectively. Survival rates were similar before and during the start of the collaboration. In multivariable analysis, the treatment variables completeness of debulking, chemotherapy, and gynecologic oncologist attendance were independent prognostic factors for overall survival, as were age, stage, and tumor grade. Conclusions: After regional collaboration, gynecologic oncologists attended more surgeries and surgical outcomes improved, but progress in survival could not be demonstrated. Regional collaboration improved care for ovarian cancer patients. Level of Evidence: II. |
| Databáze: | MEDLINE |
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