Continuous improvement in primary debulking surgery for advanced ovarian cancer: Do increased complete gross resection rates independently lead to increased progression-free and overall survival? Journal Article
| Authors: | Tseng, J. H.; Cowan, R. A.; Zhou, Q.; Iasonos, A.; Byrne, M.; Polcino, T.; Polen-De, C.; Gardner, G. J.; Sonoda, Y.; Zivanovic, O.; Abu-Rustum, N. R.; Long Roche, K.; Chi, D. S. |
| Article Title: | Continuous improvement in primary debulking surgery for advanced ovarian cancer: Do increased complete gross resection rates independently lead to increased progression-free and overall survival? |
| Abstract: | Objectives: To assess complete gross resection (CGR) rates and survival outcomes in patients with advanced ovarian cancer who underwent primary debulking surgery (PDS) during a 13-year period in which specific changes to surgical paradigm were implemented. Methods: We identified all patients with stage IIIB-IV high-grade ovarian carcinoma who underwent PDS at our institution, with the intent of maximal cytoreduction, from 1/2001–12/2013. Patients were categorized by year of PDS based on the implementation of surgical changes to our approach to ovarian cancer debulking (Group 1, 2001–2005; Group 2, 2006–2009; Group 3, 2010–2013). Results: Among 978 patients, 78% had stage IIIC disease and 89% had disease of serous histology. Carcinomatosis was found in 81%, and 60% had bulky upper abdominal disease (UAD). Compared to Group 1, those who underwent PDS during the latter 2 time periods had higher ASA scores (p < 0.001), higher-stage disease (p < 0.001), and more often had carcinomatosis (p = 0.015) and bulky UAD (p = 0.009). CGR rates for Groups 1–3 increased from 29% to 40% to 55%, respectively (p < 0.001). Five-year progression-free survival (PFS) rates increased over time (15%, 16%, and 20%, respectively; p = 0.199), as did 5-year overall survival (OS) rates (40%, 44%, and 56%, respectively; p < 0.001). On multivariable analysis, CGR was independently associated with PFS (p < 0.001) and OS (p < 0.001). Conclusions: Despite higher-stage disease and greater tumor burden, CGR rates, PFS and OS for patients who underwent PDS increased over a 13-year period. Surgical paradigm shifts implemented specifically to achieve more complete surgical cytoreduction are likely the reason for these improvements. © 2018 Elsevier Inc. |
| Keywords: | adult; cancer chemotherapy; cancer survival; controlled study; aged; survival analysis; surgical technique; survival rate; major clinical study; overall survival; histopathology; cancer recurrence; advanced cancer; cancer growth; cancer patient; cancer staging; antineoplastic agent; cancer grading; ovarian cancer; cytoreductive surgery; progression free survival; ovary cancer; tumor volume; cohort analysis; brca1 protein; retrospective study; risk factor; age; albumin; minimal residual disease; ovary carcinoma; carcinomatosis; surgical patient; abdominal disease; progression-free survival; albumin blood level; oncological parameters; primary debulking surgery; cancer prognosis; human; female; priority journal; article; prognostic assessment; american society of anesthesiologists score; complete gross resection; surgical paradigm; or tumor index |
| Journal Title: | Gynecologic Oncology |
| Volume: | 151 |
| Issue: | 1 |
| ISSN: | 0090-8258 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2018-10-01 |
| Start Page: | 24 |
| End Page: | 31 |
| Language: | English |
| DOI: | 10.1016/j.ygyno.2018.08.014 |
| PROVIDER: | scopus |
| PUBMED: | 30126704 |
| PMCID: | PMC6247423 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 October 2018 -- Source: Scopus |
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