- •18% of EOC patients in the NCDB did not receive surgical treatment.
- •22% of elderly patients with advanced disease received only systemic treatment; 23% were untreated.
- •It is unclear how often deviation from best-practices guidelines is clinically appropriate.
To identify prevalence, correlates and survival implications of non-surgically managed epithelial ovarian cancer (EOC).
The National Cancer Database (NCDB) was queried for EOC cases between 2003 and 2011. Type of treatment, survival data, reasons for non-surgical treatment, clinicopathologic and process-based factors were collected. Logistic regression identified independent predictors of surgical treatment; Cox proportional hazards regression modeled association between time to death and receipt of surgery.
172,687 of 210,667 patients (82%) received surgical treatment for EOC. 95% of patients treated non-surgically had stage III, stage IV or unknown stage disease. The reason for non-surgical treatment was unclear in 80% of cases. Black race and uninsurance were significantly associated with non-surgical treatment. Median survival time was 57.4 months (95% CI: 56.8–57.9) for surgery with or without systemic treatment compared to 11.9 months (95% CI: 11.6–12.2) for systemic treatment alone and 1.4 months (95% CI: 1.3–1.4) for no treatment. Relative to surgical treatment, the adjusted hazard ratio for death associated with systemic treatment alone was 1.9 (p < 0.001); hazard ratio for untreated patients was 4.7 (p < 0.001). Among 29,921 patients older than 75 with Stage III/IV disease, 21.5% received only systemic treatment; 22.8% were entirely untreated.
18% of EOC patients in the NCDB did not receive surgical treatment. These patients experienced significantly worsened survival. Prospective investigation is needed to determine how often apparent deviation from best-practices guidelines is clinically appropriate. Non-surgically treated patients may be at risk for poor access to gynecologic oncology care and deserve further study.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Gynecologic Oncology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
National Comprehensive Cancer Network. Clinical practice guidelines in oncology: ovarian cancer, version 2.2015.
- Ovarian cancer in the United States: contemporary patterns of care associated with improved survival.Gynecol. Oncol. 2014; https://doi.org/10.1016/j.ygyno.2014.10.023
- Predictors of comprehensive surgical treatment in patients with ovarian cancer.Cancer. 2007; 109: 2031-2042https://doi.org/10.1002/cncr.22604
- Reasons for failure to deliver National Comprehensive Cancer Network (NCCN)-adherent care in the treatment of epithelial ovarian cancer at an NCCN cancer center.Gynecol. Oncol. 2014; 133: 142-146https://doi.org/10.1016/j.ygyno.2014.02.006
- Trends in treatment of advanced epithelial ovarian cancer in the Medicare population.Gynecol. Oncol. 2011; 122: 100-106https://doi.org/10.1016/j.ygyno.2011.03.022
- Ovarian cancer outcomes: predictors of early death.Gynecol. Oncol. 2016; 140: 474-480https://doi.org/10.1016/j.ygyno.2015.12.021
- Treatment reality in elderly patients with advanced ovarian cancer: a prospective analysis of the OVCAD consortium.J. Ovarian Res. 2013; 6: 42https://doi.org/10.1186/1757-2215-6-42
- Can pre-operative computed tomography predict resectability of ovarian carcinoma at primary laparotomy?.BJOG. 2002; 109 (http://www.ncbi.nlm.nih.gov/pubmed/12013156. Accessed November 24, 2015): 369-375
- Multidetector CT predictors of incomplete resection in primary cytoreduction of patients with advanced ovarian cancer.Eur. Radiol. 2010; 20: 100-107https://doi.org/10.1007/s00330-009-1533-0
- Radical surgery in ovarian cancer.Curr. Oncol. Rep. 2015; 17: 16https://doi.org/10.1007/s11912-015-0439-z
- Is it time to centralize ovarian cancer Care in the United States?.Ann. Surg. Oncol. 2015; https://doi.org/10.1245/s10434-015-4938-9
Published online: May 04, 2016
Accepted: April 19, 2016
Received in revised form: March 28, 2016
Received: February 1, 2016
© 2016 Elsevier Inc. All rights reserved.