J Cancer 2021; 12(15):4443-4454. doi:10.7150/jca.57894

Research Paper

An Italian National Survey on Ovarian Cancer Treatment at first diagnosis. There's None so Deaf as those who will not Hear

Vincenzo Dario Mandato1✉, Federica Torricelli2, Stefano Uccella3, Debora Pirillo1, Gino Ciarlini4, Gabriele Ruffo1, Gianluca Annunziata1, Gloria Manzotti2, Sandro Pignata5, Lorenzo Aguzzoli4

1. Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
2. Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
3. Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona VR, Italy.
4. Unit of Surgical Gynecol Oncology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
5. Istituto Nazionale Tumori Fondazione Giovanni Pascale, Istituto di Ricovero e Cura a Carattere Scientifico, Napoli, Italy.

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Citation:
Mandato VD, Torricelli F, Uccella S, Pirillo D, Ciarlini G, Ruffo G, Annunziata G, Manzotti G, Pignata S, Aguzzoli L. An Italian National Survey on Ovarian Cancer Treatment at first diagnosis. There's None so Deaf as those who will not Hear. J Cancer 2021; 12(15):4443-4454. doi:10.7150/jca.57894. Available from https://www.jcancer.org/v12p4443.htm

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Abstract

Objective: Epithelial ovarian cancer (EOC) is the most lethal gynecological malignancy, crucial prognostic factors are no gross residual disease and centralization of cases. To evaluate the centralization of EOC patients, we report the results of a survey that shows the daily management of EOC patients in Italy.

Methods: A 49-items electronic unblinded survey assessing demographics, practice characteristics, current opinions and approach to managing advanced EOC at first diagnosis was sent both to general gynecologists (GG) and gynecologic oncologists (GO). Differences in frequency distribution of answers between gynecologists with different expertise were evaluated using Fisher exact test. Multivariable analyses were performed applying generalized linear models.

Results: 84/192 (44%) GG and 108/192 (56%) GO from all Italian regions answered to our survey. GOs declared to perform fertility sparing surgery in early EOC more frequently than GG (p=0.002).

GOs can perform a frozen section and have both a gynecopathologist and a dedicated general surgeon. 89% of GOs consider as “optimal debulking” no gross residual disease and 81% achieve this at upfront cytoreduction in more than 40% of patients. Use of neoadjuvant chemotherapy decreases in higher volume centers (p<0.001) while it is lower in the group of GOs than in the GGs group (p<0.001).

Conclusions: EOC patients are still treated by GGs. GOs perform more upfront surgery and achieve optimal debulking in a greater percentage of patients than GGs. In Italy an adequate centralization of cases has not yet been achieved, and this may have detrimental effects on the quality of treatment.

Keywords: epithelial ovarian cancer, centralization, survey, gynecologic oncologists, cytoreduction