Investigating the Impact of Ultra-Radical Surgery on Survival in Advanced Ovarian Cancer Using Population-Based Data in a Multicentre UK Study

Abstract

We investigated URS and impact on survival in whole patient cohorts with AOC treated within gynaecological cancer centres that participated in the previously presented SOCQER 2 study. National cancer registry datasets were used to identify FIGO Stage 3,4 and unknown stage patients from 11 cancer centres that had previously participated in the SOCQER2 study. Patient outcomes’ association with surgical ethos were evaluated using logistic regression and Cox proportional hazards. Centres were classified into three groups based on their surgical complexity scores (SCS); those practicing mainly low complexity, (5/11 centres with >70% low SCS procedures, 759 patients), mainly intermediate (3/11, 35–50% low SCS, 356 patients), or mainly high complexity surgery (3/11, >35% high SCS, 356 patients). Surgery rates were 43.2% vs. 58.4% vs. 60.9%. across mainly low, intermediate and high SCS centres, respectively, p < 0.001. Combined surgery and chemotherapy rates were 39.2% vs. 51.8% vs. 38.3% p < 0.000 across mainly low, intermediate and high complexity groups, respectively. Median survival was 23.1 (95% CI 19.0 to 27.2) vs. 22.0 (95% CI 17.6 to 26.3) vs. 17.9 months (95% CI 15.7 to 20.1), p = 0.043 in mainly high SCS, intermediate, and low SCS centres, respectively. In an age and deprivation adjusted model, compared to patients in the high SCS centres, patients in the low SCS group had an HR of 1.21 (95% CI 1.03 to 1.40) for death. Mainly high/intermediate SCS centres have significantly higher surgery rates and better survival at a population level. Centres that practice mainly low complexity surgery should change practice. This study provides support for the utilization of URS for patients with advanced OC.

British Gynaecological Cancer Society Recommendations for Evidence Based, Population Data Derived Quality Performance Indicators for Ovarian Cancer

“…This cannot be compared to trial data or institutional figures which are subject to case selection bias. Our data is in keeping with population data both from the UK [43] and Nordic countries. In setting this target, the BGCS panel considered the fact that a proportion of individual Cancer Centres will have performance well above, as well as some below, the national mean intercept for Cancer Alliances.…”

Chemotherapy Response Score in Ovarian Cancer Patients: An Overview of Its Clinical Utility

“…The ability of institutions to achieve optimal cytoreduction significantly differs worldwide, with an estimated range between 20% and 90% of cases [ 6 ]. The advances in surgical knowledge and expertise permit the completion of operations with a high surgical complexity score in our era [ 7 , 8 ]. When surgery is not considered feasible in terms of ensuring complete tumor resection, current consensus statements for ovarian cancer treatment state that neo-adjuvant chemotherapy should be provided, which must be followed by interval debulking surgery (IDS) [ 9 ].…”

Analysis of Anxiety, Depression and Fear of Progression at 12 Months Post-Cytoreductive Surgery in the SOCQER-2 (Surgery in Ovarian Cancer—Quality of Life Evaluation Research) Prospective, International, Multicentre Study

“…Maximal cytoreductive surgery has recently been endorsed by NICE as standard treatment for patients with advanced OC [ 22 ]. This was following publication of the results from the prospective observational SOCQER-2 study showing no detrimental impact on QoL and improved survival in centres offering maximal-effort cytoreductive surgery [ 23 , 24 ]. Several studies have shown improved progression-free survival (PFS) and overall survival (OS) with maximal-effort cytoreductive surgery, but we do not know its impact on patients’ psychological morbidity [ 25 ].…”