title: Centralized treatment of advanced stages of ovarian cancer improves survival: a nationwide Danish survey.
abstract: OBJECTIVE
  This retrospective, nationwide, observational study was designed to compare treatment in tertiary referral centers vs. regional hospitals on overall survival for patients with stage IIIC and IV ovarian cancer.
  
  
  METHODS
  The study took place in all gynecological departments in Denmark, involving a total of 1,160 patients with stage IIIC or IV ovarian cancer. Data were extracted for 2,024 patients with all stages of ovarian cancer recorded in the Danish Gynecological Cancer Database between 1 January 2005 and 31 December 2008. The main outcome measure was overall survival.
  
  
  RESULTS
  No difference was found between tertiary centers and regional hospitals with regard to age, body mass index, American Society of Anesthesiologists score or comorbidity. Patients in regional hospitals had poorer Eastern Cooperative Oncology Group performance status, i.e.1.0 vs. 2.0 (p= 0.005). Patients in referral centers presented more often with stage IIIC and IV disease, i.e. 59.7 vs. 51.7% (p < 0.001). Patients with stage IIIC and IV disease in regional vs. tertiary hospitals had a higher rate of primary cytoreductive surgery, i.e. 89.5 vs. 82.5% (p= 0.004), a poorer rate of complete cytoreductive surgery following primary cytoreductive surgery, i.e. 13.9 vs. 25.2% (p < 0.001), a lower rate of neoadjuvant chemotherapy, i.e. 5.5 vs. 13.4% (p < 0.001), and more often underwent acute surgery, i.e. 17.0 vs. 9.2% (p < 0.001). Patients treated in referral centers had better overall survival (p= 0.021). Treatment in a referral center was an independent prognostic factor for overall survival hazard ratio, 0.83 (confidence interval 0.70-0.98).
  
  
  CONCLUSIONS
  Patients with stage IIIC and IV ovarian cancer benefit from treatment in a tertiary referral center.
authors.affiliation: Department of Gynecology, Juliane Marie Centre, Copenhagen, Denmark. carsten.lindberg.fagoe-olsen@rh.regionh.dk
authors.forename: Carsten L
authors.initials: CL
authors.lastname: Fagö-Olsen
authors.forename: Claus
authors.initials: C
authors.lastname: Høgdall
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.forename: Ib J
authors.initials: IJ
authors.lastname: Christensen
authors.forename: Bent
authors.initials: B
authors.lastname: Ottesen
mesh_terms: D000328:Adult; D002173:Cancer Care Facilities / Q000458:organization & administration / Q000706:statistics & numerical data*; D003718:Denmark / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D016522:Oncology Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D010051:Ovarian Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D018579:Patient Selection; D011159:Population Surveillance; D011320:Primary Health Care; D011379:Prognosis; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D016387:Women's Health