Highlights
- •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.
Abstract
Purpose
To identify prevalence, correlates and survival implications of non-surgically managed
epithelial ovarian cancer (EOC).
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: May 04, 2016
Accepted:
April 19,
2016
Received in revised form:
March 28,
2016
Received:
February 1,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
