OBJECTIVE: Textbook Oncologic Outcome (TOO) is a composite measure that strongly predicts survival after surgery for advanced epithelial ovarian cancer (AEOC), regardless of approach: primary (PDS) or interval debulking surgery (IDS). We aimed to identify risk factors associated with failure to achieve TOO and to receive standard treatment (surgery and chemotherapy) for AEOC. METHODS: Patients diagnosed with AEOC between 2008 and 2019 were identified using the National Cancer Database. TOO was defined as achieving complete cytoreduction, hospital stay <
10 days, no 30-day readmission, adjuvant chemotherapy initiation <
42 days, and 90-day survival. Logistic regression models were used to identify factors associated with TOO and receipt of standard treatment. RESULTS: Among 58,635 AEOC patients, 49% received standard treatment. Of the 21,657 patients who underwent surgery, 51.4% received PDS and 48.6% IDS. For PDS multivariable analysis, factors associated with lower likelihood to achieve TOO included age >
75 years (vs <
60
OR 0.47, 95% CI 0.38-0.58), Black race (vs White
OR 0.73, 95% CI 0.59-0.90), government insurance (vs private
OR 0.82, 95% CI 0.73-0.92), high surgical complexity (vs low
OR 0.62, 95% CI 0.56-0.68), and median surgical volume ≤5 cases/year (vs ≥20
OR 0.75, 95% CI 0.63-0.89). For IDS, similar associations were observed for government insurance (OR 0.87, 95% CI, 0.80-0.96), high surgical complexity (OR 0.61, 95% CI 0.55-0.66), and median surgical volume ≤5 cases/year (OR 0.60, 95% CI 0.52-0.70). CONCLUSIONS: Several factors are associated with lower likelihood of achieving TOO after treatment for AEOC. Some of these factors (age, race, payor type) reflect disparities in care
others (facility volume, surgical complexity) highlight the need for referral to high-volume centers for initial treatment planning.