Abstract
OBJECTIVE: The aim of this study was to examine the impact of hospital surgical volume and hospital region on overall survival (OS) in patients with ovarian cancer. METHODS: This retrospective cohort study utilized nationwide claims data from Korea (2012-2020) to analyze ovarian cancer patients who underwent surgery. Hospitals were classified as high-volume (≥20) or low-volume (<20) based on the annual volume of upfront ovarian cancer surgeries. Propensity score matching (PSM) (1:1) addressed confounder imbalances between the groups. OS was assessed via Kaplan-Meier analysis, log-rank tests, and Cox regression, with subgroup analyses by cancer stage. RESULTS: A total of 11,510 patients were included in the cohort (high-volume: 8,241; low-volume: 3,269), with 3,236 matched pairs identified through PSM. Compared with low-volume hospitals, treatment at high-volume hospitals was associated with a 21% reduction in mortality risk (adjusted hazard ratio [aHR]=0.79; 95% confidence interval [CI]=0.70-0.89). This survival advantage persisted across localized/regional (aHR=0.77; 95% CI=0.63-0.95) and distant-stage disease (aHR=0.81; 95% CI=0.71-0.92). In contrast, hospital location (capital vs. noncapital) was not significantly associated with OS in the entire cohort (aHR=1.09; 95% CI=0.97-1.21) or in stage-specific analyses. CONCLUSION: These findings highlight that instead of simply distributing hospitals geographically, establishing high-volume surgical centers is crucial to improving survival outcomes for patients with ovarian cancer.