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Organization of gynaecological cancer care
105 Adherence to European ovarian cancer guidelines and impact on survival: a French multicenter study (FRANCOGYN)
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  1. F Jochum1,2,
  2. L Lecointre1,3,4,
  3. E Faller1,
  4. T Boisrame1,
  5. Y Dabi5,
  6. V Lavoue6,
  7. C Coutant7,
  8. C Touboul5,
  9. PA Bolze8,
  10. A Bricou9,
  11. G Canlorbe10,
  12. P Collinet11,
  13. C Huchon12,
  14. S Bendifallah13,
  15. L Ouldamer14,
  16. M Mezzadri15,
  17. D Querleu1,16 and
  18. C Akladios1
  1. 1Hôpitaux Universitaires de Strasbourg , Gynecology, France
  2. 2Residual Tumor and Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Paris, France
  3. 3I-Cube UMR 7357 – Laboratoire des Sciences de l’ingénieur, de l’informatique et de l’imagerie, Université de Strasbourg, Strasbourg, France
  4. 4Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
  5. 5Centre Hospitalier Intercommunal, Créteil, France
  6. 6Hôpital Universitaire de Rennes, Rennes, France
  7. 7Georges-Francois Leclerc Cancer Center, Dijon, France
  8. 8CHU Lyon-Sud, Lyon, France
  9. 9Jean–Verdier University Hospital, APHP, Paris, France
  10. 10Hôpital la Pitié Salpétrière, AP-HP, Paris, France
  11. 11Hôpital Jeanne De Flandre, CHRU Lille, Lille, France
  12. 12Centre Hospitalier de Poissy, Poissy, France
  13. 13Hôpital Tenon, AP-HP, Paris, France
  14. 14Hôpital Universitaire de Tours, Tours, France
  15. 15Hôpital Lariboisière, APHP, Paris, France
  16. 16Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy

Abstract

Objective The primary objective of this study was to validate ESMO–ESGO ovarian cancer guideline as a method of assessing quality of care and to identify patient characteristics predictive of nonadherence 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 FRANCOGYN database included data from 12 French centers between January 2000 to February 2017. The main outcome was the adherence to ESMO–ESGO guidelines, defined by recommended surgical procedures according to FIGO stage and appropriate chemotherapy. Mixed multivariable logistic regression analysis with a random center effect was performed to estimate the probability of adherence to guidelines. Survival analysis was carried out using the Kaplan-Meier method and a mixed Cox proportional hazards model.

Results A total of 1463 patients were included in this study. Overall, 317 (30%) 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 demographic 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 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% when compared to those treated according to guidelines (HR 2.14, 95% CI 1.32–3.47 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 is associated with a higher overall survival and may be a useful method of assessing quality of care.

https://doi.org/10.1136/ijgc-2021-ESGO.297

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