title: Centralisation of epithelial ovarian cancer surgery: results on survival from a peripheral teaching hospital.
abstract: OBJECTIVE
  The objective of this retrospective descriptive study was to assess overall survival and disease free survival of patients treated for epithelial ovarian cancer by a gynaecologic-oncologist in a single Dutch peripheral teaching hospital and to identify independent prognostic factors.
  
  
  METHODS
  A retrospective series of 242 patients treated for epithelial ovarian cancer between 1999 and 2011 at Meander Medical Centre was reviewed. Data on patient, tumour and treatment characteristics were collected. Outcomes were overall survival and progression free survival. Data were analysed using the Kaplan-Meier method, log-rank test and Cox regression analysis.
  
  
  RESULTS
  Median follow-up was 35 months (range 1-203). Staging procedures were performed in 81 patients of which 63% were complete. 61% of patients had advanced stage disease. In 46%, debulking surgery was complete. Five-year overall survival and progression free survival for all patients was 52% and 47%, respectively. Multivariate analysis identified performance status [HR=1.89 and 1.92 for performance status 2, HR=7.01 and 2.69 for performance status 3], FIGO stage [HR=3.59 for stage II, HR=5.43 and 5.64 for stage III, HR=12.17 and 10.21 for stage IV] and residual disease after debulking surgery [HR=2.01 and 1.72 for incomplete debulking] as independent prognostic factors for overall survival and progression free survival respectively.
  
  
  CONCLUSIONS
  Survival after surgery for epithelial ovarian cancer in this cohort is comparable to survival in centralised clinics presented in literature. Partial concentration of cancer care by recruitment of specialised gynaecologic-oncologists in teaching hospitals might be an alternative to complete centralisation of epithelial ovarian cancer treatment in larger cancer centres.
authors.affiliation: Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, The Netherlands. Electronic address: marleenvliet@gmail.com.
authors.forename: Marleen M L
authors.initials: MM
authors.lastname: van Vliet
authors.affiliation: Division of Women and Baby, Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Henk W R
authors.initials: HW
authors.lastname: Schreuder
authors.affiliation: Meander Academy, Department of Epidemiology and Statistics, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: Pieternel C M
authors.initials: PC
authors.lastname: Pasker-de Jong
authors.affiliation: Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: M Jitze
authors.initials: MJ
authors.lastname: Duk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D065426:Cytoreduction Surgical Procedures; D003695:Delivery of Health Care / Q000458:organization & administration*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D009426:Netherlands; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D017239:Paclitaxel / Q000008:administration & dosage; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D003520:Cyclophosphamide; D016190:Carboplatin; D017239:Paclitaxel
keywords: Centralisation; Epithelial ovarian cancer; Prognostic factors; Quality of care; Specialisation; Survival