The National Cancer Database report on advanced-stage epithelial ovarian cancer

Impact of hospital surgical case volume on overall survival and surgical treatment paradigm

Robert E. Bristow, Bryan E. Palis, Dennis S. Chi, William Arthur Cliby

Research output: Contribution to journalArticle

132 Citations (Scopus)

Abstract

Objective: To examine the effect of hospital procedure volume and other prognostic variables on overall survival outcome and likelihood of receiving standard recommended care among patients with advanced-stage epithelial ovarian cancer. Methods: The National Cancer Data Base (NCDB) was searched for patients undergoing primary treatment for FIGO Stage IIIC/IV epithelial ovarian cancer from 1996 to 2005. The average annual surgical procedure volume was derived for each reporting hospital. Quartile ranking discriminated four groups of hospitals based on annual surgical volume: low (< 9), intermediate (9-20), high (21-35), and very high (> 35). Cox proportional hazards modeling was used to determine the impact on overall survival of hospital surgical volume adjusted for treatment, FIGO/AJCC stage, ethnicity, age, payer status, household income, and tumor grade. Binomial multivariate logistic regression modeling was used to assess differences in patient demographic, tumor, and treatment variables between high/very high volume hospitals and low/intermediate volume hospitals. Results: A total of 45,929 patients were identified. After adjusting for other factors, overall survival was significantly correlated with hospital case volume: very high (reference); high (HR 0.98, 95% CI = 0.92-1.04); intermediate (HR 1.08, 95% CI = 1.01-1.15); and low (HR 1.14, 95% CI = 1.07-1.22). Compared to low and intermediate volume hospitals, patients treated at very high and high-volume hospitals were less likely to receive neo-adjuvant chemotherapy (OR = 0.33, 95% CI = 1.18-1.50) or surgery alone (OR = 0.77, 95% CI = 0.73-0.82) instead of initial surgery and adjuvant chemotherapy. Conclusions: Hospital ovarian cancer surgical volume ≥ 21 cases/year is associated with a higher likelihood of patients with Stage IIIC/IV epithelial ovarian cancer receiving standard treatment (surgery followed by adjuvant chemotherapy). Even after adjusting for treatment paradigm and other factors, hospital volume ≥ 21 cases/year was significantly predictive of improved overall survival outcome.

Original languageEnglish (US)
Pages (from-to)262-267
Number of pages6
JournalGynecologic Oncology
Volume118
Issue number3
DOIs
StatePublished - Sep 2010

Fingerprint

Cancer Care Facilities
Databases
Survival
Low-Volume Hospitals
Adjuvant Chemotherapy
High-Volume Hospitals
Neoplasms
Therapeutics
Ovarian epithelial cancer
Ovarian Neoplasms
Patient Care
Logistic Models
Demography

Keywords

  • Ovarian cancer
  • Surgical volume
  • Survival

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

The National Cancer Database report on advanced-stage epithelial ovarian cancer : Impact of hospital surgical case volume on overall survival and surgical treatment paradigm. / Bristow, Robert E.; Palis, Bryan E.; Chi, Dennis S.; Cliby, William Arthur.

In: Gynecologic Oncology, Vol. 118, No. 3, 09.2010, p. 262-267.

Research output: Contribution to journalArticle

@article{64f965957d8d453392ee29bc0c371bf5,
title = "The National Cancer Database report on advanced-stage epithelial ovarian cancer: Impact of hospital surgical case volume on overall survival and surgical treatment paradigm",
abstract = "Objective: To examine the effect of hospital procedure volume and other prognostic variables on overall survival outcome and likelihood of receiving standard recommended care among patients with advanced-stage epithelial ovarian cancer. Methods: The National Cancer Data Base (NCDB) was searched for patients undergoing primary treatment for FIGO Stage IIIC/IV epithelial ovarian cancer from 1996 to 2005. The average annual surgical procedure volume was derived for each reporting hospital. Quartile ranking discriminated four groups of hospitals based on annual surgical volume: low (< 9), intermediate (9-20), high (21-35), and very high (> 35). Cox proportional hazards modeling was used to determine the impact on overall survival of hospital surgical volume adjusted for treatment, FIGO/AJCC stage, ethnicity, age, payer status, household income, and tumor grade. Binomial multivariate logistic regression modeling was used to assess differences in patient demographic, tumor, and treatment variables between high/very high volume hospitals and low/intermediate volume hospitals. Results: A total of 45,929 patients were identified. After adjusting for other factors, overall survival was significantly correlated with hospital case volume: very high (reference); high (HR 0.98, 95{\%} CI = 0.92-1.04); intermediate (HR 1.08, 95{\%} CI = 1.01-1.15); and low (HR 1.14, 95{\%} CI = 1.07-1.22). Compared to low and intermediate volume hospitals, patients treated at very high and high-volume hospitals were less likely to receive neo-adjuvant chemotherapy (OR = 0.33, 95{\%} CI = 1.18-1.50) or surgery alone (OR = 0.77, 95{\%} CI = 0.73-0.82) instead of initial surgery and adjuvant chemotherapy. Conclusions: Hospital ovarian cancer surgical volume ≥ 21 cases/year is associated with a higher likelihood of patients with Stage IIIC/IV epithelial ovarian cancer receiving standard treatment (surgery followed by adjuvant chemotherapy). Even after adjusting for treatment paradigm and other factors, hospital volume ≥ 21 cases/year was significantly predictive of improved overall survival outcome.",
keywords = "Ovarian cancer, Surgical volume, Survival",
author = "Bristow, {Robert E.} and Palis, {Bryan E.} and Chi, {Dennis S.} and Cliby, {William Arthur}",
year = "2010",
month = "9",
doi = "10.1016/j.ygyno.2010.05.025",
language = "English (US)",
volume = "118",
pages = "262--267",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",
number = "3",

}

TY - JOUR

T1 - The National Cancer Database report on advanced-stage epithelial ovarian cancer

T2 - Impact of hospital surgical case volume on overall survival and surgical treatment paradigm

AU - Bristow, Robert E.

AU - Palis, Bryan E.

AU - Chi, Dennis S.

AU - Cliby, William Arthur

PY - 2010/9

Y1 - 2010/9

N2 - Objective: To examine the effect of hospital procedure volume and other prognostic variables on overall survival outcome and likelihood of receiving standard recommended care among patients with advanced-stage epithelial ovarian cancer. Methods: The National Cancer Data Base (NCDB) was searched for patients undergoing primary treatment for FIGO Stage IIIC/IV epithelial ovarian cancer from 1996 to 2005. The average annual surgical procedure volume was derived for each reporting hospital. Quartile ranking discriminated four groups of hospitals based on annual surgical volume: low (< 9), intermediate (9-20), high (21-35), and very high (> 35). Cox proportional hazards modeling was used to determine the impact on overall survival of hospital surgical volume adjusted for treatment, FIGO/AJCC stage, ethnicity, age, payer status, household income, and tumor grade. Binomial multivariate logistic regression modeling was used to assess differences in patient demographic, tumor, and treatment variables between high/very high volume hospitals and low/intermediate volume hospitals. Results: A total of 45,929 patients were identified. After adjusting for other factors, overall survival was significantly correlated with hospital case volume: very high (reference); high (HR 0.98, 95% CI = 0.92-1.04); intermediate (HR 1.08, 95% CI = 1.01-1.15); and low (HR 1.14, 95% CI = 1.07-1.22). Compared to low and intermediate volume hospitals, patients treated at very high and high-volume hospitals were less likely to receive neo-adjuvant chemotherapy (OR = 0.33, 95% CI = 1.18-1.50) or surgery alone (OR = 0.77, 95% CI = 0.73-0.82) instead of initial surgery and adjuvant chemotherapy. Conclusions: Hospital ovarian cancer surgical volume ≥ 21 cases/year is associated with a higher likelihood of patients with Stage IIIC/IV epithelial ovarian cancer receiving standard treatment (surgery followed by adjuvant chemotherapy). Even after adjusting for treatment paradigm and other factors, hospital volume ≥ 21 cases/year was significantly predictive of improved overall survival outcome.

AB - Objective: To examine the effect of hospital procedure volume and other prognostic variables on overall survival outcome and likelihood of receiving standard recommended care among patients with advanced-stage epithelial ovarian cancer. Methods: The National Cancer Data Base (NCDB) was searched for patients undergoing primary treatment for FIGO Stage IIIC/IV epithelial ovarian cancer from 1996 to 2005. The average annual surgical procedure volume was derived for each reporting hospital. Quartile ranking discriminated four groups of hospitals based on annual surgical volume: low (< 9), intermediate (9-20), high (21-35), and very high (> 35). Cox proportional hazards modeling was used to determine the impact on overall survival of hospital surgical volume adjusted for treatment, FIGO/AJCC stage, ethnicity, age, payer status, household income, and tumor grade. Binomial multivariate logistic regression modeling was used to assess differences in patient demographic, tumor, and treatment variables between high/very high volume hospitals and low/intermediate volume hospitals. Results: A total of 45,929 patients were identified. After adjusting for other factors, overall survival was significantly correlated with hospital case volume: very high (reference); high (HR 0.98, 95% CI = 0.92-1.04); intermediate (HR 1.08, 95% CI = 1.01-1.15); and low (HR 1.14, 95% CI = 1.07-1.22). Compared to low and intermediate volume hospitals, patients treated at very high and high-volume hospitals were less likely to receive neo-adjuvant chemotherapy (OR = 0.33, 95% CI = 1.18-1.50) or surgery alone (OR = 0.77, 95% CI = 0.73-0.82) instead of initial surgery and adjuvant chemotherapy. Conclusions: Hospital ovarian cancer surgical volume ≥ 21 cases/year is associated with a higher likelihood of patients with Stage IIIC/IV epithelial ovarian cancer receiving standard treatment (surgery followed by adjuvant chemotherapy). Even after adjusting for treatment paradigm and other factors, hospital volume ≥ 21 cases/year was significantly predictive of improved overall survival outcome.

KW - Ovarian cancer

KW - Surgical volume

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=77955549719&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77955549719&partnerID=8YFLogxK

U2 - 10.1016/j.ygyno.2010.05.025

DO - 10.1016/j.ygyno.2010.05.025

M3 - Article

VL - 118

SP - 262

EP - 267

JO - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

IS - 3

ER -