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Adherence to European ovarian cancer guidelines and impact on survival: a French multicenter study (FRANCOGYN)
  1. Floriane Jochum1,
  2. Tamara De Rozario1,
  3. Lise Lecointre2,3,
  4. Emilie Faller1,
  5. Thomas Boisrame1,
  6. Yohann Dabi4,
  7. Vincent Lavoué5,
  8. Charles Coutant6,
  9. Cyril Touboul4,
  10. Pierre-Adrien Bolze7,
  11. Alexandre Bricou8,
  12. Geoffroy Canlorbe9,
  13. Pierre Collinet10,
  14. Cyrille Huchon11,
  15. Sofiane Bendifallah12,
  16. Lobna Ouldamer13,
  17. Mathieu Mezzadri14,
  18. Denis Querleu1,15 and
  19. Chérif Akladios1
  1. 1 Department of Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
  2. 2 I-Cube UMR 7357-Laboratoire des Sciences de l’ingénieur, de l’informatique et de l’imagerie, Université de Strasbourg, Strasbourg, France
  3. 3 Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
  4. 4 Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Creteil, Creteil, France
  5. 5 Department of Gynecologic Surgery, Hôpital Universitaire de Rennes, Université de Rennes 1 Faculté de Médecine, Rennes, France
  6. 6 Department of Surgical Oncology, Georges-Francois Leclerc Centre, Dijon, France
  7. 7 Gynecological Surgery Service, CHU Lyon, Lyon, France
  8. 8 Department of Obstetrics and Gynecology, Hôpital Jean Verdier, Bondy, France
  9. 9 Department of Gynecologic and Breast Surgery and Oncology, Hopital Universitaire Pitie Salpetriere Bibliotheque de La Pitie, Paris, France
  10. 10 Department of Gynecological Surgery, Hopital Jeanne de Flandre, Lille, France
  11. 11 Department of Gynecology, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye Site Hospitalier de Poissy, Poissy, France
  12. 12 Department of Gynecology and Obstetrics, Hôpital Tenon, APHP, Paris, France
  13. 13 Department of Gynecology, Hôpital Universitaire de Tours, Tours, France
  14. 14 Department of Gynecology, Hôpital Lariboisière, Paris, France
  15. 15 Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
  1. Correspondence to Dr Floriane Jochum, Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg 67200, France; jochum.floriane{at}


Objective The primary objective of the study was to validate the European Society for Medical Oncology (ESMO)–European Society of Gynecologic Oncology (ESGO) ovarian cancer guideline as a method of assessing quality of care, and to identify patient characteristics predictive of non-adherence to European guideline care. The secondary objectives were to analyze the evolution of practices over the years and to evaluate heterogeneity between centers.

Methods This retrospective multicenter cohort study of invasive epithelial ovarian cancer reported to the FRANCOGYN database included data from 12 French centers between January 2000 and February 2017. The main outcome was adherence to ESMO–ESGO guidelines, defined by recommended surgical procedures according to the International Federation of Gynecology and Obstetrics (FIGO) stage and appropriate chemotherapy. Mixed multivariable logistic regression analysis with a random center effect was performed to estimate the probability of adherence to the guidelines. Survival analysis was carried out using the Kaplan–Meier method and a mixed Cox proportional hazards model.

Results 1463 patients were included in the study. Overall, 317 (30%) patients received complete guideline adherent care. Patients received appropriate surgical treatment in 69% of cases, while adequate chemotherapy was administered to 44% of patients. Both patient demographics and disease characteristics were significantly associated with the likelihood of receiving guideline adherent care, such as age, performance status, FIGO stage, and initial burden of disease. In univariate and multivariate survival analysis, adherence to the guidelines was a statistically significant and independent predictor of decreased overall survival. Patients receiving suboptimal care experienced an increased risk of death of more than 100% compared with those treated according to the guidelines (hazard ratio 2.14, 95% confidence interval 1.32 to 3.47, p<0.01). In both models, a significant random center effect was observed, confirming the heterogeneity between centers (p<0.001).

Conclusions Adherence to ESMO–ESGO guidelines in ovarian cancer was associated with a higher overall survival and may be a useful method of assessing quality of care.

  • ovarian cancer
  • surgical oncology
  • medical oncology

Data availability statement

Data are available upon reasonable request. Data are available on request.

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Data availability statement

Data are available upon reasonable request. Data are available on request.

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  • Contributors Conceptualization: FJ and CA. Validation: LL and DQ. Formal analysis: FJ and CA. Investigation/data curation: TD, EF, TB, YD, VL, CC, CT, P-AB, AB, GC, PC, CH, SB, LO, and MM. Original draft: FJ and TD. Review: all authors. Visualization: FJ. Supervision: CA, LL, and DQ. All authors revised the manuscript for important intellectual content. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.