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718 Investigating impact of ultra-radical surgery in advanced ovarian cancer using population level data linked to the SOCQER 2 multicentre study
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  1. SS Sundar1,
  2. C Cummins2,
  3. J Balega3,
  4. T Broadhead4,
  5. T Duncan5,
  6. R Edmondson6,
  7. C Fotopoulou7,
  8. D Kolomainen8,
  9. S Kumar2,
  10. R Manchanda9,
  11. J Morrison10,
  12. J Tidy11 and
  13. N Wood12
  1. 1Institute of Cancer and Genomic Sciences, University of Birmingham, UK
  2. 2University of Birmingham, Institute of Applied Health Research, Birmingham, UK
  3. 3Pan Birmingham gynaecological cancer centre, City Hospital, Birmingham
  4. 4Leeds Hospital NHS trust
  5. 5Norfolk and Norwich University Hospitals NHS trust
  6. 6University of Manchester
  7. 7Imperial University Hospitals NHS trust
  8. 8Southend Hospitals NHS trust
  9. 9Barts and the London Hospitals NHS trust
  10. 10Taunton Hospitals NHS Trust
  11. 11Sheffield Hospitals NHS trust
  12. 12Lancashire Hospitals NHS trust

Abstract

Introduction/Background*The first population study investigating per protocol implementation of ultra-radical surgery (URS) as primary surgery reported that URS in advanced ovarian cancer (AOC) reduces the proportion treated surgically and does not improve survival.1 We investigated this hypothesis using population level data for centers participating in the SOCQER 2 study

Methodology The SOCQER2 study investigated quality of life after surgery of varying complexity for AOC in a prospective multicenter cohort study, recruiting for 12 months with 24 months follow-up. Results of QoL and variation in Surgical Complexity Scores (SCS) have been previously reported. 2 SOCQER2 centers diverged in approach to URS; used routinely in some participating centers and not in others. Here we analyzed data from nationally collected datasets (Cancer Outcome and Services Data, Systemic Anti-Cancer Treatment, Hospital Episode Statistics) to investigate survival and treatment outcomes in the total cohort of patients from the cancer centers that participated in the SOCQER 2 study, including patients with FIGO Stage 3,4, and stage unknown AOC patients. Residual disease post-surgery was not available for analysis.

Result(s)*1521 patients across 11 participating centers clustered into 3 groups – centers performing >70% low SCS (5/11), mainly intermediate SCS >40% (3/11) and mainly high SCS surgery > 35% (3/11) with 788, 365 and 368 patients. The proportion of patients receiving standard of care, surgery and chemotherapy, was similar in both low and high SCS groups and highest in the intermediate group (39.2 vs 38.3 vs 51.8, p<0.000) (table 1). Median survival was 24.0 vs 22.4 vs 18.8 months in the high, intermediate and low SCS centers, log rank test p=0.051, (figure 1).

Abstract 718 Table 1

Proportion of treatment received in centres participating in the SOCQER2 study—population data analysis. Stage 3, 4 and stage unknown patients

Abstract 718 Figure 1

Kaplan Meir Survival curve. Log rank test p=0.051

Conclusion*This multicenter ‘ real-life’ population based study finds that URS does not reduce the proportion of AOC patients treated surgically. Centers with mainly intermediate SCS have higher proportion receiving surgery and chemotherapy; this may reflect a willingness to accept greater optimal rather than complete cytoreduction rates. Centers with greater radicality trend towards improved survival, but this did not reach statistical significance. A larger population level study to identify ideal intermediate: high SCS ratios is urgently needed.

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