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Implementation of National Guidelines increased survival in advanced ovarian cancer - A population-based nationwide SweGCG study

Dahm-Kähler, Pernilla ; Holmberg, Erik LU ; Holtenman, Mikael ; Rådestad, Angelique Flöter ; Borgfeldt, Christer LU ; Hjerpe, Elisabet ; Marcickiewicz, Janusz ; Bjurberg, Maria LU ; Tholander, Bengt and Hellman, Kristina , et al. (2021) In Gynecologic Oncology 161(1). p.244-250
Abstract

Aim: The first Swedish National Guidelines for Ovarian Cancer (NGOC) were published in 2012. We aimed to evaluate surgical outcomes and survival in patients with stage IIIC-IV disease, before and after the NGOC implementation. Method: Women with primary epithelial ovarian cancer, FIGO stage IIIC–IV, registered in the Swedish Quality Registry for Gynecologic Cancer 2008–2011 and 2013–2016 were included. Surgical outcomes were analyzed, including frequency of complete cytoreduction (R0). Relative survival (RS) and excess mortality rate ratios (EMRRs) were computed as measures of survival. Univariable and multivariable regression (Poisson) were calculated. Results: In total, 3728 women were identified, 1746 before and 1982 after NGOC.... (More)

Aim: The first Swedish National Guidelines for Ovarian Cancer (NGOC) were published in 2012. We aimed to evaluate surgical outcomes and survival in patients with stage IIIC-IV disease, before and after the NGOC implementation. Method: Women with primary epithelial ovarian cancer, FIGO stage IIIC–IV, registered in the Swedish Quality Registry for Gynecologic Cancer 2008–2011 and 2013–2016 were included. Surgical outcomes were analyzed, including frequency of complete cytoreduction (R0). Relative survival (RS) and excess mortality rate ratios (EMRRs) were computed as measures of survival. Univariable and multivariable regression (Poisson) were calculated. Results: In total, 3728 women were identified, 1746 before and 1982 after NGOC. After adjusting for age and stage, survival was improved 2013–2016 vs. 2008–2011 (EMRR 0.89; 95%CI:0.82–0.96, p < 0.05). For women undergoing primary debulking surgery (PDS), R0 frequency (28.9% vs. 53.3%; p < 0.001) and 5-year RS (29.6% (95%CI:26.8–32.8) vs. 37.4% (95%CI:33.6–41.7)) were increased, but fewer patients (58% vs. 44%, p < 0.001) underwent PDS after NGOC implementation. Median survival for the PDS cohort increased from 35 months (95%CI,32.8–39.2) to 43 months (95%CI,40.9–46.4). In the neoadjuvant chemotherapy (NACT) + interval debulking surgery (IDS) cohort, R0 increased (36.8% to 50.1%, p < 0.001), but not 5-year RS (17.5% vs. 20.7%, ns). Compared to PDS, the EMRR was 1.32 (95%CI,1.19–1.47, p < 0.001) for NACT+IDS and 3.00 (95%CI,2.66–3.38, p < 0.001) for chemotherapy alone. In multivariable analyses, PDS, R0, age ≤ 70 years, and stage IIIC were found to be independent factors for improved RS. Conclusion: Implementation of the first National Guidelines for Ovarian Cancer improved relative survival in advanced ovarian cancer.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Centralization, Guideline, Interval debulking surgery, Neoadjuvant chemotherapy, Ovarian cancer, Primary debulking surgery, Radicality, Survival
in
Gynecologic Oncology
volume
161
issue
1
pages
244 - 250
publisher
Academic Press
external identifiers
  • scopus:85100818309
  • pmid:33581846
ISSN
0090-8258
DOI
10.1016/j.ygyno.2021.01.012
language
English
LU publication?
yes
id
07269628-3884-4acf-902d-419d2fb04811
date added to LUP
2021-03-04 11:35:11
date last changed
2024-06-13 08:01:01
@article{07269628-3884-4acf-902d-419d2fb04811,
  abstract     = {{<p>Aim: The first Swedish National Guidelines for Ovarian Cancer (NGOC) were published in 2012. We aimed to evaluate surgical outcomes and survival in patients with stage IIIC-IV disease, before and after the NGOC implementation. Method: Women with primary epithelial ovarian cancer, FIGO stage IIIC–IV, registered in the Swedish Quality Registry for Gynecologic Cancer 2008–2011 and 2013–2016 were included. Surgical outcomes were analyzed, including frequency of complete cytoreduction (R0). Relative survival (RS) and excess mortality rate ratios (EMRRs) were computed as measures of survival. Univariable and multivariable regression (Poisson) were calculated. Results: In total, 3728 women were identified, 1746 before and 1982 after NGOC. After adjusting for age and stage, survival was improved 2013–2016 vs. 2008–2011 (EMRR 0.89; 95%CI:0.82–0.96, p &lt; 0.05). For women undergoing primary debulking surgery (PDS), R0 frequency (28.9% vs. 53.3%; p &lt; 0.001) and 5-year RS (29.6% (95%CI:26.8–32.8) vs. 37.4% (95%CI:33.6–41.7)) were increased, but fewer patients (58% vs. 44%, p &lt; 0.001) underwent PDS after NGOC implementation. Median survival for the PDS cohort increased from 35 months (95%CI,32.8–39.2) to 43 months (95%CI,40.9–46.4). In the neoadjuvant chemotherapy (NACT) + interval debulking surgery (IDS) cohort, R0 increased (36.8% to 50.1%, p &lt; 0.001), but not 5-year RS (17.5% vs. 20.7%, ns). Compared to PDS, the EMRR was 1.32 (95%CI,1.19–1.47, p &lt; 0.001) for NACT+IDS and 3.00 (95%CI,2.66–3.38, p &lt; 0.001) for chemotherapy alone. In multivariable analyses, PDS, R0, age ≤ 70 years, and stage IIIC were found to be independent factors for improved RS. Conclusion: Implementation of the first National Guidelines for Ovarian Cancer improved relative survival in advanced ovarian cancer.</p>}},
  author       = {{Dahm-Kähler, Pernilla and Holmberg, Erik and Holtenman, Mikael and Rådestad, Angelique Flöter and Borgfeldt, Christer and Hjerpe, Elisabet and Marcickiewicz, Janusz and Bjurberg, Maria and Tholander, Bengt and Hellman, Kristina and Kjølhede, Preben and Högberg, Thomas and Rosenberg, Per and Åvall-Lundqvist, Elisabeth and Stålberg, Karin}},
  issn         = {{0090-8258}},
  keywords     = {{Centralization; Guideline; Interval debulking surgery; Neoadjuvant chemotherapy; Ovarian cancer; Primary debulking surgery; Radicality; Survival}},
  language     = {{eng}},
  month        = {{02}},
  number       = {{1}},
  pages        = {{244--250}},
  publisher    = {{Academic Press}},
  series       = {{Gynecologic Oncology}},
  title        = {{Implementation of National Guidelines increased survival in advanced ovarian cancer - A population-based nationwide SweGCG study}},
  url          = {{http://dx.doi.org/10.1016/j.ygyno.2021.01.012}},
  doi          = {{10.1016/j.ygyno.2021.01.012}},
  volume       = {{161}},
  year         = {{2021}},
}