What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)? Journal Article

  

Authors:	Chi, D. S.; Eisenhauer, E. L.; Lang, J.; Huh, J.; Haddad, L.; Abu-Rustum, N. R.; Sonoda, Y.; Levine, D. A.; Hensley, M.; Barakat, R. R.
Article Title:	What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)?
Abstract:	Objective.: Recent studies have suggested that the definition of optimal cytoreduction for advanced EOC should be changed from the current Gynecologic Oncology Group threshold of ≤1 cm residual disease to no gross residual disease owing to improved survival of patients (pts) rendered macroscopically disease-free. The objective of this study was to analyze survival rates at very specific residual disease diameters to determine the optimal goal of primary cytoreduction for bulky stage IIIC EOC. Methods.: A prospectively kept database was used to identify and review the records of all pts with Stage IIIC EOC who underwent primary cytoreductive surgery at our institution between January 1989 and December 2003. To analyze a homogeneous cohort of cases, we excluded pts with stage IIIC disease based on nodal metastasis alone (without bulky abdominal tumor), fallopian tube or primary peritoneal carcinomas, and borderline tumors. Standard statistical analyses were utilized. Results.: The study cohort included 465 pts. The median age was 60 years (range, 25-87), and the median follow-up was 38 months (range, 1-199). Univariate and multivariate analyses, which included various prognostic factors, identified amount of residual disease as a significant prognostic factor (P < 0.001). Median overall survival in relation to the 5 residual disease categories was: no gross residual, 106 months; gross ≤0.5 cm, 66 months; 0.6-1.0 cm, 48 months; 1-2 cm, 33 months; >2 cm, 34 months. Statistical comparison between the 5 residual disease categories revealed 3 distinct groups with significantly different survival rates (P < 0.01). These 3 groups were: (1) no gross residual; (2) gross ≤1 cm residual; and (3) >1 cm residual. Although the difference in survival did not reach statistical significance, within the gross ≤1 cm residual group, there was a trend toward improved survival in pts left with smaller volume, ≤0.5 cm residual compared with those with 0.6-1.0 cm residual (P = 0.06). Conclusion.: Our data suggest that removal of all evidence of macroscopic disease is associated with prolonged survival and should be the goal of primary cytoreductive surgery. If complete gross resection is not feasible, however, cytoreduction to as minimal residual tumor as possible should be the focus of cytoreductive efforts, as each incremental decrease in residual disease below 1 cm may be associated with an incremental improvement in overall survival. © 2006 Elsevier Inc. All rights reserved.
Keywords:	survival; adult; cancer survival; controlled study; aged; aged, 80 and over; middle aged; survival rate; major clinical study; comparative study; cancer staging; follow up; lymph node metastasis; neoplasm staging; prospective studies; cytoreductive surgery; ovarian neoplasms; peritoneum cancer; tumor volume; cohort analysis; data base; statistical analysis; statistical significance; neoplasm, residual; medical record; ovary carcinoma; epithelial cells; gynecologic surgical procedures; multivariate analysis; advanced ovarian cancer; optimal cytoreduction; univariate analysis; uterine tube; residual disease; abdominal tumor
Journal Title:	Gynecologic Oncology
Volume:	103
Issue:	2
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2006-11-01
Start Page:	559
End Page:	564
Language:	English
DOI:	10.1016/j.ygyno.2006.03.051
PUBMED:	16714056
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-33750145025&partnerID=40&md5=acb41affd4905655b91a84f319c02674
Notes:	--- - "Export Date: 4 June 2012" - "CODEN: GYNOA" - "Source: Scopus"

https://synapse.mskcc.org/synapse/works/has_related_data_chk/27100