The effect of primary cytoreduction on outcomes of patients with FIGO stage IIIC ovarian cancer stratified by the initial tumor burden in the upper abdomen cephalad to the greater omentum Journal Article

   

Authors:	Zivanovic, O.; Sima, C. S.; Iasonos, A.; Hoskins, W. J.; Pingle, P. R.; Leitao, M. M. Jr; Sonoda, Y.; Abu-Rustum, N. R.; Barakat, R. R.; Chi, D. S.
Article Title:	The effect of primary cytoreduction on outcomes of patients with FIGO stage IIIC ovarian cancer stratified by the initial tumor burden in the upper abdomen cephalad to the greater omentum
Abstract:	Objective: Our objective was to analyze the effect of surgical outcome on progression-free survival (PFS) and overall survival (OS) of patients with advanced ovarian carcinoma stratified by the initial presence and volume of upper abdominal disease cephalad to the greater omentum (UAD) found at the time of exploration. Methods: We evaluated all patients with FIGO stage IIIC ovarian carcinoma who underwent primary cytoreduction followed by platinum-based chemotherapy at our institution between January 1989 and December 2006. The effect of surgical outcome was investigated using a time-to-event analysis. A Cox proportional hazards model was fit using clinical, surgical, and postoperative variables. Results: We identified 526 evaluable patients. Optimal versus suboptimal cytoreduction was significantly associated with improved median PFS and OS in patients with no, minimal (≤ 1 cm), and bulky (> 1 cm) UAD. On multivariate analysis, patients with bulky UAD who underwent optimal cytoreduction had a 28% decreased risk of relapse (hazard ratio, 0.72; 95% confidence interval: 0.53-0.99; P = 0.04) and a 33% decreased risk of death (hazard ratio, 0.67; 95% confidence interval: 0.47-0.96; P = 0.03) compared to patients who underwent suboptimal cytoreduction. Conclusion: The presence of large-volume disease found during surgical exploration does not preclude the benefit of optimal cytoreduction. The findings support the management strategy of maximizing surgical efforts with increasing tumor burden in patients with stage IIIC ovarian cancer. Prospective studies are needed to more precisely quantify tumor burden and accurately determine the specific impact of cytoreduction on outcome. © 2009 Elsevier Inc. All rights reserved.
Keywords:	survival; adult; controlled study; human tissue; treatment outcome; treatment response; aged; aged, 80 and over; disease-free survival; middle aged; survival rate; major clinical study; overall survival; cancer localization; advanced cancer; cancer combination chemotherapy; antineoplastic agents; cancer patient; combined modality therapy; cancer staging; neoplasm staging; ovarian cancer; cytoreductive surgery; ovarian neoplasms; progression free survival; multiple cycle treatment; peritoneal neoplasms; proportional hazards models; tumor burden; cancer size; ovary carcinoma; surgery; cancer relapse; therapy effect; platinum derivative; cytoreduction; taxane derivative; organoplatinum compounds; upper abdominal disease; omentum; upper abdominal disease cephalad to the greater omentum; greater omentum
Journal Title:	Gynecologic Oncology
Volume:	116
Issue:	3
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2010-03-01
Start Page:	351
End Page:	357
Language:	English
DOI:	10.1016/j.ygyno.2009.11.022
PUBMED:	20022092
PROVIDER:	scopus
PMCID:	PMC4843127
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-75749085167&partnerID=40&md5=5409b6d4c92e277f22e572e4f24d4d12
Notes:	--- - "Cited By (since 1996): 3" - "Export Date: 20 April 2011" - "CODEN: GYNOA" - "Source: Scopus"

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