Article Text

other Versions

Download PDFPDF
Quality of therapy in early ovarian cancer: results of the quality assurance program of the AGO Study Group
  1. Pauline Wimberger1,
  2. Jacobus Pfisterer2,
  3. Andreas du Bois3,
  4. Felix Hilpert4,
  5. Markus Kerkman5,
  6. Jalid Sehouli6,
  7. Sven Mahner7,
  8. Nikolaus de Gregorio8,
  9. Lars Hanker9,
  10. Florian Heitz3,
  11. Frederik Marmé10,
  12. Linn Woelber11,
  13. Laura Holtmann5,
  14. Gabriele Elser12 and
  15. Philipp Harter3
  16. for the AGO Study Group
  1. 1Gynecology and Obstetrics, Technische Universitat Dresden Medizinische Fakultat Carl Gustav Carus, Dresden, Germany
  2. 2Gynecologic Cancer Center, Kiel, Germany
  3. 3Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
  4. 4Oncologic Therapy Center Hospital Jerusalem, Hamburg, Germany
  5. 5MMF GmbH, Münster, Germany
  6. 6Gynecology with Center of Oncological Surgery, Charité University Berlin, Berlin, Germany
  7. 7Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Munich, Germany
  8. 8Klinikum am Gesundbrunnen, SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
  9. 9University Hospital Schleswig-Holstein, University Hospital Schleswig-Holstein, Lubeck, Germany
  10. 10Department of Gynecology, University Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
  11. 11Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  12. 12AGO Study Group Wiesbaden, Wiesbaden, Germany
  1. Correspondence to Professor Pauline Wimberger, Gynecology and Obstetrics, Technische Universitat Dresden Medizinische Fakultat Carl Gustav Carus, Dresden 01307, Germany; pauline.wimberger{at}


Objective The quality assurance program for ovarian cancer (QS-OVAR) evaluates the implementation of treatment standards and impact on survival for International Federation of Gynecology and Obstetrics (FIGO) stage I ovarian cancer.

Methods Patients with a first diagnosis of ovarian cancer, diagnosed in the third quarter of 2004, 2008, 2012, and 2016, were documented. Surgical quality was categorized as optimal (maximum one surgical item missing) versus suboptimal (≥2 surgical items missing). Chemotherapy was defined as optimal according to national guidelines. Treatment quality was classified into four categories: surgery and chemotherapy were optimal, optimal surgery and suboptimal chemotherapy, suboptimal surgery and optimal chemotherapy, and surgery and chemotherapy were suboptimal.

Results In total, 19.9% (n=700) of ovarian cancer patients were diagnosed with FIGO stage I. Median age was 60 years (range 18–96), 47.1% had FIGO stage IA and 47.9% had stage IC, with 37.1% high grade serous histology. Optimal surgical quality increased over time from 19.9% to 54.1%. The optimal surgery population increased from 42.2% to 70.9%. Disease free survival improved significantly in the optimal surgery population (84% after 48 months vs 71% in the suboptimal surgery population). Overall survival increased with 91% after 48 months in the optimal surgery population versus 76% in the suboptimal surgery population. In total, 20.7% of patients were undertreated concerning systemic treatment and 1% overtreated. Optimal chemotherapy standard was administered increasingly over time (71.4–80.8%). Disease free survival and overall survival were prolonged with adjuvant chemotherapy. The optimal surgery/chemotherapy subgroup increased from 37.9% to 54.1% with significantly longer disease free survival and overall survival (overall survival at 48 months: optimal surgery and chemotherapy 93%; suboptimal surgery and chemotherapy 68%).

Conclusion Although QS-OVAR data showed that the quality of therapy has improved over the years, not all surgical standards were met in nearly 50% of patients. The steady increase in the optimal surgery and chemotherapy collective is an important tool for improvement of prognosis of ovarian cancer patients.

  • ovarian cancer

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

View Full Text


  • Contributors PW wrote the main manuscript text and is designated as the guarantor of this subanalysis. AdB (2004 and 2008), JP (2012), and PH (2016) are the principal investigators of the respective cohort studies. All authors were involved in the conceptualization and methodology of the study. All authors were involved in the analysis of the data and reviewed the manuscript.

  • Funding This study was funded by the AGO Study Group. The study was supported by unrestricted research grants from AstraZeneca, Amgen, Boehringer Ingelheim, GlaxoSmithKline, Roche, and Essex to the AGO Study Group.

  • Competing interests None declared.

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

  • © IGCS and ESGO 2023. No commercial re-use. See rights and permissions. Published by BMJ.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.