Survival outcomes of acute normovolemic hemodilution in patients undergoing primary debulking surgery for advanced ovarian cancer: A Memorial Sloan Kettering Cancer Center Team Ovary study Journal Article

   

Authors:	Boerner, T.; Tanner, E.; Filippova, O.; Zhou, Q. C.; Iasonos, A.; Tew, W. P.; O'Cearbhaill, R. E.; Grisham, R. N.; Gardner, G. J.; Sonoda, Y.; Abu-Rustum, N. R.; Zivanovic, O.; Long Roche, K.; Afonso, A. M.; Fischer, M.; Chi, D. S.
Article Title:	Survival outcomes of acute normovolemic hemodilution in patients undergoing primary debulking surgery for advanced ovarian cancer: A Memorial Sloan Kettering Cancer Center Team Ovary study
Abstract:	Objective: To describe oncologic outcomes after using acute normovolemic hemodilution (ANH) to reduce requirement for allogenic red blood cell transfusions (ABT) in patients undergoing primary debulking surgery (PDS) for advanced ovarian cancer. Methods: We performed a post-hoc analysis of a recent prospective trial investigating the safety and feasibility of ANH during PDS for advanced ovarian cancer. We report long-term survival outcomes. We compared demographics, clinicopathological characteristics, survival outcomes in this cohort of Stage IIIB-IVB high-grade serous ovarian cancer patients undergoing ANH (ANH group), with a retrospective cohort of all other patients (standard group) undergoing PDS during the same time period (01/2012–04/2017). Standard statistical tests were used. Results: There were no demographic or clinicopathological differences between ANH (n = 33) and standard groups (n = 360), except for higher median age at diagnosis (57 vs. 62 years, respectively; p = 0.044) and shorter operative time (357 vs. 446 min, respectively; p < 0.001) in the standard group. Cytoreductive outcomes (ANH vs. standard): 0 mm, 69.7 vs. 63.9%; gross residual disease (RD) ≤1 cm, 21.2 vs. 26.9%; >1 cm, 9.1 vs. 9.2% (p = 0.78). RD after PDS was the only independent factor associated with worse progression-free survival (PFS) on multivariable analysis (p < 0.001). Patients with BRCA mutations trended towards improved PFS (p = 0.057). Significant factors for overall survival (OS) on multivariable analysis: preoperative CA125 (p = 0.004), ascites (p = 0.018), RD after PDS (p = 0.04), BRCA mutation status (p < 0.001). After adjustment for potential confounders, ANH was not independently associated with PFS or OS [PFS: HR 0.928 (0.618–1.395); p = 0.721; OS: HR 0.588 (95%CI: 0.317–1.092); p = 0.093]. Conclusions: ANH is an innovative approach in intraoperative management. It was previously proven to decrease need for ABT while maintaining the ability to achieve complete gross resection and associated benefits. © 2020 Elsevier Inc.
Keywords:	adult; cancer survival; controlled study; aged; cancer surgery; gene mutation; major clinical study; overall survival; advanced cancer; cancer patient; cancer staging; outcome assessment; endometrium carcinoma; ovarian cancer; cytoreductive surgery; disease association; progression free survival; ovary cancer; cohort analysis; retrospective study; electronic medical record; hospitalization; hemodilution; intraoperative period; operation duration; perioperative period; clear cell carcinoma; erythrocyte transfusion; blood volume; surgical patient; acute normovolemic hemodilution; primary debulking surgery; long term survival; human; female; priority journal; article; allogenic blood transfusion
Journal Title:	Gynecologic Oncology
Volume:	160
Issue:	1
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2021-01-01
Start Page:	51
End Page:	55
Language:	English
DOI:	10.1016/j.ygyno.2020.10.042
PUBMED:	33213899
PROVIDER:	scopus
PMCID:	PMC8378264
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85096372874&doi=10.1016%2fj.ygyno.2020.10.042&partnerID=40&md5=1c4540790e666a8a7409d8263d1a54cc
Notes:	Article -- Export Date: 1 February 2021 -- Source: Scopus

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