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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2020.tde-19082020-230856
Document
Author
Full name
Vinicius Cesar Moterani
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2020
Supervisor
Committee
Reis, Francisco José Cândido dos (President)
Magnani, Pedro Sergio
Reis, Ricardo dos
Title in Portuguese
Relação entre sobrevida pelo câncer de ovário e volume de cirurgias em hospitais do estado de São Paulo
Keywords in Portuguese
Câncer de ovário
Cirurgia
Epidemiologia
Sobrevida
Abstract in Portuguese
Introdução: O câncer epitelial de ovário é uma doença altamente heterogênea. Cirurgia e quimioterapia são ambos componentes importantes do tratamento. Nós avaliamos neste estudo a importância do tipo de hospital na sobrevida global de pacientes portadoras de câncer epitelial ovariano. Objetivos: Nosso objetivo foi identificar se as características do hospital impactaram a sobrevida global do paciente. Nós consideramos tanto características quantitativas (o volume de pacientes portadoras de câncer de ovário) quanto qualitativas (ser um hospital escola ou não). Métodos: Uma coorte histórica foi estabelecida com os dados fornecidos pela Fundação Oncocentro de São Paulo (FOSP). Pacientes eram mulheres tratadas para câncer de ovário no estado de São Paulo de janeiro de 2000 a dezembro de 2018. Informação foi coletada quanto a idade, tipo histológico, estadio, cirurgia, quimioterapia e tipo do hospital. Nós classificamos os hospitais tanto quantiativamente quanto qualitativamente. Quando a mediana de número de pacientes com câncer de ovário tratados na instituição era 20 ou mais, ela era considerada um hospital de alto volume; do contrário, era considerado um hospital de baixo volume. Nós usamos a portaria interministerial do Ministério da Saúde e da Educação para determinar quais instituições eram hospitals escola; todos os outros foram classificados como hospitais regulares. Resultado: Hospitais de alto volume (HR 0.86, 95% IC: 0.80-0.92, p < 0.001) e hospitais escola (HR 0.91, 95% IC: 0.85- 0.99, p = 0.019) foram associados a um risco menor de morte. Probabilidade de ser submetido a cirurgia foi maior em hospitais de alto volume comparado a hospitais de baixo volume (80.0% contra 71.1%, p < 0.001). Um menor número de pacientes em hospitais de alto volume foi submetido a quimioterapia comparado a hospitais de baixo volume (68.5% contra 74.5%, p < 0.001). Mais de 52% dos pacientes com câncer de ovário epitelial no estado de São Paulo foram tratados em hospitais de alto volume. Conclusão: A sobrevida global foi melhor de forma independente quando o paciente foi tratado em hospitais de alto volume ou hospitais escola. A análise exploratória demonstrou uma alta porcentagem de pacientes tratados em hospitais de alto volume e um uso inesperadamente mais alto de quimioterapia em hospitais de baixo volume. Estudos adicionais são necessários para explicar esses resultados.
Title in English
Relationship between ovarian cancer survival and surgery volume in hospitals in the state of Sao Paulo
Keywords in English
Epidemiology
Ovarian cancer
Surgery
Survival
Abstract in English
Introduction: Epithelial ovarian cancer is a highly heterogenous disease. Surgery and chemotherapy both are important parts of the treatment. We assessed in this study the importance of the type of hospital in the overall survival of epithelial ovarian cancer patients. Objectives: Our goal was to identify whether hospital characteristics impacted the overall survival of the patient. We considered both quantitative characteristics (the ovarian cancer patient volume) and qualitative characteristics (being either teaching or community hospital). Methods: A retrospective cohort study was established with data recorded by the Fundação Oncocentro de São Paulo (FOSP). Patients were women treated for ovarian cancer in the state of Sao Paulo from January 2000 to December 2018. Information was gathered on age, histology, staging, surgery, chemotherapy and the type of hospital. We classified hospitals both quantitatively and qualitatively. When the median ovarian cancer number of patients treated in that institution was 20 or higher, it was considered a high-volume hospital; otherwise, it was considered a low-volume hospital. We used the interministerial ordinance by the Ministry of Health and Education to determinate which institutions were teaching hospitals; all others were classified as community hospitals. Results: High volume hospitals (HR: 0.86, 95% CI 0.8-0.92, p < 0.001) and teaching hospitals (HR: 0.91, 95% CI 0.85-0.99, p = 0.019) were associated with low risk of death. Likelihood of undergoing surgery was higher in high-volume compared to low-volume hospitals (80.0% versus 71.1%, p < 0.001). A smaller number of patients in high-volume hospitals were submitted to chemotherapy compared to low-volume hospitals (68.5% versus 74.5%, p < 0.001). More than 52% of the epithelial ovarian cancer patients in the state of Sao Paulo were treated in high-volume hospitals. Conclusion: Overall survival improved independently when patients were treated in high-volume hospitals and teaching hospitals. Exploratory analysis showed a high percentage of patients treated in high-volume hospitals and an unexpected higher usage of chemotherapy in low-volume hospitals. Additional studies are required to further explain these results.
 
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Publishing Date
2020-10-21
 
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