Impact of multidisciplinary tumour board in the management of ovarian carcinoma in the first-line setting. Exhaustive analysis from the Rhone-Alpes region.

OBJECTIVE: Epithelial ovarian cancer (EOC) is a poor prognosis disease partly linked to diagnosis at an advanced stage. The quality of care management is a factor that needs to be explored, more specifically optimal organisation of first-line treatment. METHODS: A retrospective study, dealing with all patients diagnosed within the Rhone-Alpes region with initial diagnosis EOC in 2012, was performed. The aim was to describe the impact of multidisciplinary tumour boards (MTB) in the organisation of care and the consequence on the patient's outcomes. RESULTS: 271 EOC were analysed. 206 patients had an advanced EOC. Median progression-free survival (PFS) is 17.8 months (CI95%, 14.6-21.2) for AOC. 157 patients (57.9%) had a front-line surgery versus 114 patients (42.1%) interval debulking surgery. PFS for AOC patients with no residual disease is 24.3 months compared with 15.3 months for patients with residual disease (p = .01). No macroscopic residual disease is more frequent in the patients discussed before surgery in MTB compared with patients not submitted before surgery (73% vs. 56.2%, p < .001). CONCLUSION: These results highlight the heterogeneity of medical practices in terms of front-line surgery versus interval surgery, in the administration of neoadjuvant chemotherapy and in the setting of MTB discussion.

Being treated in higher volume hospitals leads to longer progression-free survival for epithelial ovarian carcinoma patients in the Rhone-Alpes region of France.

BACKGROUND: To investigate the relationship between hospital volume activities and the survival for Epithelial Ovarian Carcinoma (EOC) patients in France. METHODS: This retrospective study using prospectively implemented databases was conducted on an exhaustive cohort of 267 patients undergoing first-line therapy during 2012 in the Rhone-Alpes Region of France. We compared Progression-Free Survival for Epithelial Ovarian Carcinoma patients receiving first-line therapy in high- (i.e. ≥ 12 cases/year) vs. low-volume hospitals. To control for selection bias, multivariate analysis and propensity scores were used. An adjusted Kaplan-Meier estimator and a univariate Cox model weighted by the propensity score were applied. RESULTS: Patients treated in the low-volume hospitals had a probability of relapse (including death) that was almost two times (i.e. 1.94) higher than for patients treated in the high-volume hospitals (p < 0.001). CONCLUSION: To our knowledge, this is the first study conducted in this setting in France. As reported in other countries, there was a significant positive association between greater volume of hospital care for EOC and patient survival. Other factors may also be important such as the quality of the surgical resection.

Modeling CA-125 During Neoadjuvant Chemotherapy for Predicting Optimal Cytoreduction and Relapse Risk in Ovarian Cancer.

AIM: To investigate the prognostic value of modeled CA-125 kinetic parameters regarding surgery outcomes and time to second-line chemotherapy in a population of ovarian cancer patients treated with neoadjuvant chemotherapy followed by interval cytoreduction. PATIENTS AND METHODS: This retrospective study included consecutive patients with FIGO stage IIIc/IV ovarian cancer treated between 2006 and 2014. We characterized CA-125 kinetics and identified modeled kinetic parameters. RESULTS: Fifty four patients were included. KELIM (modeled CA-125 elimination rate constant) was an independent predictive parameter of optimal cytoreduction (OR=0.18; 95% CI=0.04-0.69; p=0.02). In the optimal cytoreduction population (40 patients, 74.1%), E50 (concentration producing 50% of the maximum chemotherapy effect) was a significant prognostic parameter regarding time to second-line chemotherapy (HR=0.38; 95% CI=0.173-0.854; p=0.019). CONCLUSION: We identified CA-125 modeled kinetic parameters during neoadjuvant chemotherapy harboring potential predictive values regarding the likelihood of optimal cytoreduction, along with time to second-line chemotherapy in optimally-cytoreduced patients.