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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Health Services Research 1/2018

Being treated in higher volume hospitals leads to longer progression-free survival for epithelial ovarian carcinoma patients in the Rhone-Alpes region of France

BMC Health Services Research > Ausgabe 1/2018
Marius Huguet, Lionel Perrier, Olivia Bally, David Benayoun, Pierre De Saint Hilaire, Dominique Beal Ardisson, Magali Morelle, Nathalie Havet, Xavier Joutard, Pierre Meeus, Philippe Gabelle, Jocelyne Provençal, Céline Chauleur, Olivier Glehen, Amandine Charreton, Fadila Farsi, Isabelle Ray-Coquard
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12913-017-2802-2) contains supplementary material, which is available to authorized users.



To investigate the relationship between hospital volume activities and the survival for Epithelial Ovarian Carcinoma (EOC) patients in France.


This retrospective study using prospectively implemented databases was conducted on an exhaustive cohort of 267 patients undergoing first-line therapy during 2012 in the Rhone-Alpes Region of France. We compared Progression-Free Survival for Epithelial Ovarian Carcinoma patients receiving first-line therapy in high- (i.e. ≥ 12 cases/year) vs. low-volume hospitals. To control for selection bias, multivariate analysis and propensity scores were used. An adjusted Kaplan-Meier estimator and a univariate Cox model weighted by the propensity score were applied.


Patients treated in the low-volume hospitals had a probability of relapse (including death) that was almost two times (i.e. 1.94) higher than for patients treated in the high-volume hospitals (p < 0.001).


To our knowledge, this is the first study conducted in this setting in France. As reported in other countries, there was a significant positive association between greater volume of hospital care for EOC and patient survival. Other factors may also be important such as the quality of the surgical resection.
Additional file 1: Log-Log progression free survival curves comparing LVH and HVH. Displays the log-log survival curves (threshold of 12 cases), which are a transformation of the standard Kaplan Meier estimator. These curves can be used to test the proportional hazard assumption. Indeed, the hazard is proportional if the two curves look parallel, meaning that the hazard ratio is constant over time. In our case, the two curves doesn’t looks parallel and even cross each other at the bottom right of the plot, meaning that the hazard is not proportional. (PDF 77 kb)
Additional file 2: Common support of the distribution of the propensity score. Displays the distribution of the propensity score for treated and untreated patients (threshold of 12 cases). The common support seems to be sufficient to allow for use of the matching method. (PDF 6 kb)
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