JAMA Netw Open. 2025 Jul 1;8(7):e2523434. doi: 10.1001/jamanetworkopen.2025.23434.
ABSTRACT
IMPORTANCE: Death after cytoreductive surgery for advanced-stage ovarian cancer is more frequent in low-volume hospitals. Neoadjuvant chemotherapy (NACT) has been shown to reduce surgical complexity, complications, and surgical mortality without compromising oncologic outcomes.
OBJECTIVE: To measure whether more frequent NACT utilization is associated with postoperative mortality and overall survival after cytoreductive surgery, especially in low-volume hospitals.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included patients treated for newly diagnosed stage III or IV epithelial ovarian cancer at Commission on Cancer-accredited cancer programs in the United States between January 2010 and December 2019. Data were analyzed from August 2023 to April 2025.
EXPOSURES: The main exposures of interest were cancer program-level rates of NACT and tertile of program mean annual volume of cytoreductive surgery (<12.0, 12.0-23.9, or ≥24.0 cases/y).
MAIN OUTCOMES AND MEASURES: Standardized rates and odds ratios (ORs) for 90-day perioperative morality and differences in 60-month life expectancy (restricted mean survival time).
RESULTS: A total of 70 707 patients (mean [SD] age, 63.1 [12.1] years; 5807 [8.2%] Black, 4745 [6.7%] Hispanic, and 56 336 [79.7%] White) treated in 1333 programs were identified. After adjusting for observed demographic and clinical covariates, 90-day surgical mortality was lower in centers with higher NACT rates, and the magnitude of this association differed by hospital volume (P for interaction < .001). High utilization of NACT (59%) compared with low utilization (22%) was associated with a larger decrease in 90-day mortality in high-volume centers (OR, 0.26; 95% CI, 0.17-0.41; rates, 10.0% vs 2.9%) compared with average-volume centers (OR, 0.49; 95% CI, 0.33-0.72; rates, 7.3% vs 3.7%) or low-volume centers (OR, 0.48; 95% CI, 0.39-0.60; rates, 9.5% vs 4.8%). Among high-volume centers, high utilization was associated with a 4.0 month (95% CI, 1.6-6.5 month)-improvement in 60-month life expectancy compared with low NACT utilization (42.2 vs 38.1 months).
CONCLUSIONS AND RELEVANCE: In this cross-sectional study, treatment in high-volume centers with high NACT utilization was associated with the lowest 90-day surgical mortality and longest 60-month survival for patients with advanced stage ovarian cancer.
PMID:40711787 | DOI:10.1001/jamanetworkopen.2025.23434
