In a cross-sectional study reported in JAMA Network Open, Abel et al found that higher rates of neoadjuvant chemotherapy (NACT) and a higher annual volume of cytoreductive surgery were associated with better survival outcomes in patients treated at Commission on Cancer–accredited cancer programs in the United States.
As stated by the investigators, “Death after cytoreductive surgery for advanced-stage ovarian cancer is more frequent in low-volume hospitals. NACT has been shown to reduce surgical complexity, complications, and surgical mortality without compromising oncologic outcomes.”
Study Details
The study included patients treated for newly diagnosed stage III or IV epithelial ovarian cancer at the accredited cancer programs between January 2010 and December 2019. The variables of interest were program-level rates of NACT (high = 90th percentile, low = 10th percentile) and tertile of program mean annual volume of cytoreductive surgery (< 12.0, 12.0–23.9, or ≥ 24.0 cases/year; low, average, high). The primary outcome measures were rates and odds ratios (ORs) for 90-day perioperative mortality and differences in life expectancy within 60 months of diagnosis (restricted mean survival time; mean survival time within 60 months of diagnosis). Data were analyzed between August 2023 and April 2025.
Key Findings
Among 70,707 patients from 1,333 programs included in the analysis, mean age was 63.1±12.1 years; 8.2% were Black, 6.7% Hispanic, and 79.7% White.
Adjusting for demographic and clinical covariates, 90-day surgical mortality was lower in centers with higher NACT rates, with the magnitude of the association differing according to hospital case volume (P for interaction < .001). For example, high utilization (59%) vs low utilization (22%) of NACT was associated with a larger decrease in 90-day mortality in high-volume centers (2.9% vs 10.0%; OR = 0.26, 95% CI = 0.17–0.41) compared with average-volume centers (3.7% vs 7.3%; OR = 0.49, 95% CI = 0.33–0.72) and low-volume centers (4.8% vs 9.5%; OR = 0.48, 95% CI = 0.39–0.60).
Among high-volume centers, high NACT utilization was associated with a 4.0-month (95% CI = 1.6–6.5 months) improvement in mean survival time within 60 months of diagnosis compared with low NACT utilization (42.2 vs 38.1 months). Mean survival time within 60 months of diagnosis did not differ significantly among patients treated in high vs low NACT–utilizing centers with average case volume (39.6 vs 39.4 months) or low case volume (37.9 vs 39.1 months).
The investigators concluded: “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.”
Alexander Melamed, MD, MPH, of Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, is the corresponding author for the JAMA Network Open article.
Disclosure: This study was supported by the Department of Defense Ovarian Cancer Research Program. For full disclosures of all study authors, visit jamanetwork.com.
