Welchen Einfluss haben Klinikmerkmale auf die Prognose beim Ovarialkarzinom in Deutschland?

Zusammenfassung

Ziel: Analyse des Zusammenhangs zwischen Klinikmerkmalen auf Therapiequalität und Ergebnisse beim Ovarialkarzinom in Deutschland. Methode: Zweite nationale Erhebung bei Patientinnen mit histologisch gesichertem epithelialen Ovarialkarzinom und Diagnose im 3. Quartal 2001. Beschreibung der Therapie beim frühen (FIGO I-II A) und fortgeschrittenen Ovarialkarzinom (FIGO II B-IV). Univariate und multivariate Analyse der Rolle von Klinikmerkmalen als Prognosefaktoren. Als Klinikmerkmale wurden Versorgungsstufe (Universität vs. Zentral-/Maximal-Versorgung vs. Schwerpunkt-Versorgung vs. Grund-/Regel-Versorgung), Anzahl der pro Jahr behandelten Patientinnen (1-19 vs. 20 + OP/Jahr) und Studienteilnahme untersucht. Ergebnisse: 165 Kliniken dokumentierten 476 Patientinnen, entsprechend etwa einem Drittel aller in Q III in Deutschland diagnostizierten Ovarialkarzinome. Patientinnen, die in Studienkliniken behandelt wurden erhielten häufiger eine Standardtherapie und hatten eine höhere Überlebenschance (multivariat HR 1,71; 95 % KI 1,2-2,5; p = 0,007); nach 2 Jahren lebten noch 72 % der Patientinnen in Studienkliniken, in Nicht-Studienkliniken nur 64 %. Weder Versorgungsstufe noch Anzahl der pro Jahr behandelten Patientinnen (hospital-volume) zeigten einen signifikanten Einfluss auf das Überleben. Nur in Sub-Analysen beobachteten wir einen Zusammenhang zwischen Versorgungsstufe und Therapiestandard beim frühen Ovarialkarzinom; ebenso fanden sich bei Detailanalysen zur Operation Vorteile für höhere Versorgungsstufe und bei high-volume Zentren. Schlussfolgerung: Das Klinikmerkmal Studienteilnahme war das einzige nachprüfbare Kriterium für bessere Therapiequalität und Ergebnisse. Die niedergelassenen Ärzte sollten das Qualitätskriterium Studienteilnahme mit in ihre Beratung von Patientinnen mit Ovarialkarzinom einfließen lassen. Die Teilnahme sowohl an Studien, als auch an der Qualitätssicherung der AGO kann im Internet für jede Klinik überprüft werden (www.eierstock-krebs.de).

Abstract

Purpose: To evaluate the relationship between hospital characteristics and quality of care and outcome in ovarian cancer in Germany. Methods: This 2nd national survey in patients with histologically proven epithelial ovarian cancer diagnosed in the 3^rd quarter 2001 analyzed pattern of care in early (FIGO I-II A) and advanced (FIGO II B-IV) disease. We performed univariate and multivariate analysis of the role of hospital characteristics, like hospital-volume, participation in cooperative clinical studies, and hospital category (university vs central clinic vs. two lower categories in Germany) as prognostic factor. Results: 165 hospitals documented 476 patients (= about one third of all patients diagnosed in Germany within one quarter). Patients treated in study-centres received more frequently standard care and showed superior survival (multivariate analysis including biologic prognostic factors: HR 1.71; 95 % CI 1.2-2.5; p = 0.007). 2-year-survival was 72 % and 64 % in study-centres and hospitals not participating in studies, respectively. Neither hospital category nor hospital-volume showed any significant impact on survival. Only analysis of surrogate parameters like pattern of care in early ovarian cancer revealed advantages related to hospital category. Furthermore, analysis of some surgical details revealed advantages for high-volume centres and hospital category. Conclusion: Participation in clincal studies was the only transparent hospital characteristic with significant impact on prognosis of ovarian cancer. Study participation as criterion for quality of care should be included in counselling ovarian cancer patients and should help guiding selection of hospitals for primary therapy. All German hospitals with information about participation in cooperative clinical studies as well as in this quality assurance program are listed in the web (www.eierstock-krebs.de).

Schlüsselwörter

Ovarialkarzinom - Versorgungsstruktur - Versorgungsqualität - hospital-volume - Studien - Studienteilnahme

Key words

Ovarian neoplasm - pattern of care - quality of care - hospital-volume - cooperative clinical study - study participation

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