C Lenck1, N Chopin2, S Gouy3, H Bonsang-Kitzis4, C Martinez-Gomez5, N Radosevic-Robin6, S Martin7, C Lefeuvre-Plesse8, E Lambaudie9, E Leblanc10, F Guyon11, J-M Classe12, R Ramanah13, F Beurrier2, M A Angeles5, C Pomel14, F Joly15, T de la Motte Rouge8, M Provansal16, A Lesoin17, A Floquet18, D Berton19, E Kalbacher20, C Chakiba18, P Meeus2, F Selle21, I Treilleux22, F Lecuru4, P Pautier23, I Ray-Coquard24. 1. Surgery, Centre Léon Bérard, Lyon, France. Electronic address: celinelenck@sfr.fr. 2. Surgery, Centre Léon Bérard, Lyon, France. 3. Surgery, Gustave Roussy, Villejuif, and GINECO Group, France. 4. Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Georges Pompidou, Paris, France. 5. Surgery, Institut universitaire du cancer, Toulouse, France. 6. Pathology, Centre Jean Perrin, Clermont-Ferrand, and GINECO Group, France. 7. Surgery, Centre François Baclesse, Caen, France. 8. Medical Oncology, Centre Eugene Marquis, Rennes, and GINECO Group, France. 9. Surgery, Institut Paoli Calmettes, Marseille, France. 10. Surgery, Centre Oscar Lambret, Lille, France. 11. Surgery, Institut Bergonié, Bordeaux, and GINECO Group, France. 12. Surgery, Institut de cancérologie de l'Ouest, Nantes, and GINECO Group, France. 13. Surgery, CHRU de Besançon, Hôpital Jean Minjoz, Besançon, France. 14. Surgery, Centre Jean Perrin, Clermont-Ferrand, and GINECO Group, France. 15. Medical Oncology, Centre Francois Baclesse, Caen, and GINECO Group, France. 16. Medical Oncology, Institut Paoli Calmettes, Marseille, and GINECO Group, France. 17. Medical Oncology, Centre Oscar Lambret, Lille, and GINECO Group, France. 18. Medical Oncology, Institut Bergonié, Bordeaux, and GINECO Group, France. 19. Medical Oncology, Institut de Cancérologie de l'Ouest (site René Gauducheau), Nantes, and GINECO Group, France. 20. Medical Oncology, CHRU de Besançon, Hôpital Jean Minjoz, Besançon, and GINECO Group, France. 21. Medical Oncology, Groupe hospitalier Diaconesses Croix Saint Simon, Hôpital de La Croix Saint Simon, Paris, and GINECO group, France. 22. Pathology, Centre Léon Bérard, Lyon, and GINECO Group, France. 23. Medical Oncology, Gustave Roussy, Villejuif, and GINECO Group, France. 24. Medical Oncology, Centre Léon Bérard, Lyon, and GINECO Group, France; University Claude Bernard Lyon 1, HESPER EA7425, Lyon, France. Electronic address: isabelle.ray-coquard@lyon.unicancer.fr.
Abstract
OBJECTIVE: The French national rare gynecological tumor network has been established to improve the quality of care through offering expertise in double reading histological diagnosis, reviewing cases and guiding management of these tumors through specialized multidisciplinary tumor boards and online clinical guidelines (www.ovaire-rare.com). The aim of this study is to evaluate the impact of the development and implementation of this network by assessing the conformity of medical practice with the guidelines concerning the granulosa cell tumors (GCTs). METHODS: This is a French nationwide study, including 463 patients (out of the 639 identified patients) with a definitive diagnosis of GCT between 2011 and 2016. Surgical practices were analyzed for conformity with the current guidelines (www.ovaire-rare.org). Medical records, surgical and pathological reports were systematically analyzed. Total conformity was defined by a conservative (unilateral salpingo-oophorectomy) or radical surgery (hysterectomy and bilateral salpingo-oophorectomy) including surgical staging (omentectomy, peritoneal biopsies and peritoneal cytology) according to the FIGO stage. Partial conformity referred to a conservative or radical surgery without surgical staging and non-conformity was defined as a non-optimal surgery as recommended by the guidelines. RESULTS: Median age at diagnosis was 49 years old (range 10-89). The median size of tumor was 94 mm (range 5-400). Radical surgery was performed in 240 patients (52%); while a fertility-sparing surgery was performed in 98 cases (21%). A surgical staging was performed in 76 cases (16%) and an evaluation of the endometrium in 289 cases (62%). Surgery was fully compliant with the guidelines in 65 patients (14%), partially compliant in 213 patients (46%), non-compliant in 137 patients (30%) and not assessable in 48 cases (10%). A statistically significant difference for compliance was observed in restaging surgery (p < 0,001), radical surgery (p = 0,017) and the period (before or after) of the implementation of the network (p < 0,001). Survival analyses did not allow us to demonstrate a significant difference in overall survival nor in PFS although there was a trend in favor of optimal surgery compared to incomplete/non optimal surgery. CONCLUSION: Surgical management's conformity to the guidelines increases over time from 2011 to 2016. According to this study, the implementation of a national network dedicated to rare gynecologic tumors seems to significantly improve the surgical management of the patients with ovarian granulosa cell tumors.
OBJECTIVE: The French national rare gynecological tumor network has been established to improve the quality of care through offering expertise in double reading histological diagnosis, reviewing cases and guiding management of these tumors through specialized multidisciplinary tumor boards and online clinical guidelines (www.ovaire-rare.com). The aim of this study is to evaluate the impact of the development and implementation of this network by assessing the conformity of medical practice with the guidelines concerning the granulosa cell tumors (GCTs). METHODS: This is a French nationwide study, including 463 patients (out of the 639 identified patients) with a definitive diagnosis of GCT between 2011 and 2016. Surgical practices were analyzed for conformity with the current guidelines (www.ovaire-rare.org). Medical records, surgical and pathological reports were systematically analyzed. Total conformity was defined by a conservative (unilateral salpingo-oophorectomy) or radical surgery (hysterectomy and bilateral salpingo-oophorectomy) including surgical staging (omentectomy, peritoneal biopsies and peritoneal cytology) according to the FIGO stage. Partial conformity referred to a conservative or radical surgery without surgical staging and non-conformity was defined as a non-optimal surgery as recommended by the guidelines. RESULTS: Median age at diagnosis was 49 years old (range 10-89). The median size of tumor was 94 mm (range 5-400). Radical surgery was performed in 240 patients (52%); while a fertility-sparing surgery was performed in 98 cases (21%). A surgical staging was performed in 76 cases (16%) and an evaluation of the endometrium in 289 cases (62%). Surgery was fully compliant with the guidelines in 65 patients (14%), partially compliant in 213 patients (46%), non-compliant in 137 patients (30%) and not assessable in 48 cases (10%). A statistically significant difference for compliance was observed in restaging surgery (p < 0,001), radical surgery (p = 0,017) and the period (before or after) of the implementation of the network (p < 0,001). Survival analyses did not allow us to demonstrate a significant difference in overall survival nor in PFS although there was a trend in favor of optimal surgery compared to incomplete/non optimal surgery. CONCLUSION: Surgical management's conformity to the guidelines increases over time from 2011 to 2016. According to this study, the implementation of a national network dedicated to rare gynecologic tumors seems to significantly improve the surgical management of the patients with ovarian granulosa cell tumors.