Introduction/Background Ovarian cancer is the leading cause of death due to gynecological cancers, the majority are diagnosed in advanced stages. The first Swedish national guidelines for ovarian cancer, implemented in 2012, recommended centralization to tertiary centres and primary debulking surgery (PDS) to no macroscopic residual disease (R0) as gold standard. Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) was recommended according to predefined criteria. The aim of this study was to evaluate overall survival (OS) before and after the implementation of the national guidelines.
Methodology Women diagnosed with epithelial ovarian/fallopian tube cancers FIGO stages III-IV and registered in the population-based nationwide Swedish Quality Registry for Gynecologic Cancer (SQRGC) between 2008–2016 were eligible excluding those diagnosed in 2012. Comparisons of OS before and after the implementation, 2008–2011vs 2013–2016, were performed in the cohorts of PDS, NACT+IDS and the total cohort. Overall survival (OS) was assessed by the Kaplan-Meier method and log rank test. The validity of SQRGC has previously been reported.1
Results In total, 3196 women were included in the study (n=1577 before and n=1619 after the implemented guidelines). PDS was performed in 937 (59%) women before and in 1038 (64%) women after the guidelines were introduced. During the same time periods the proportion of complete cytoreduction to R0 increased from 33% to 58%. In the PDS cohort, 5-year OS rate increased significantly from 29% (95% CI: 26–32%) to 40% (95% CI: 36–44%). In the NACT+IDS cohort, no significant difference in OS was observed. In the total cohort, 5-year OS increased significantly from 25% (95% CI: 23–28%) before to 34% (95% CI: 31–37%) after the introduction of national guidelines.
Conclusion Centralization and implementation of the first Swedish national guidelines significantly improved 5-year overall survival in the total cohort of stages III-IV epithelial ovarian cancer.
Disclosure Nothing to disclose.
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