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Menderes G, Black JD, Azodi M. The role of minimally invasive interval debulking surgery in advanced epithelial ovarian cancer. Expert Rev Anticancer Ther 2016; 16:899-901. [PMID: 27477495 DOI: 10.1080/14737140.2016.1219658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Gulden Menderes
- a Department of Obstetrics, Gynecology, and Reproductive Sciences, Section of Gynecologic Oncology , Yale School of Medicine , New Haven , CT , USA
| | - Jonathan D Black
- a Department of Obstetrics, Gynecology, and Reproductive Sciences, Section of Gynecologic Oncology , Yale School of Medicine , New Haven , CT , USA
| | - Masoud Azodi
- a Department of Obstetrics, Gynecology, and Reproductive Sciences, Section of Gynecologic Oncology , Yale School of Medicine , New Haven , CT , USA
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A laparoscopic risk-adjusted model to predict major complications after primary debulking surgery in ovarian cancer: A single-institution assessment. Gynecol Oncol 2016; 142:19-24. [DOI: 10.1016/j.ygyno.2016.04.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/14/2016] [Accepted: 04/16/2016] [Indexed: 11/18/2022]
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Prognostic impact of the time interval from primary surgery to intravenous chemotherapy in high grade serous ovarian cancer. Gynecol Oncol 2016; 141:466-470. [DOI: 10.1016/j.ygyno.2016.04.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 04/09/2016] [Accepted: 04/15/2016] [Indexed: 01/25/2023]
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Wright JD, Tergas AI, Hou JY, Burke WM, Huang Y, Hu JC, Hillyer GC, Ananth CV, Neugut AI, Hershman DL. Trends in Periodic Surveillance Testing for Early-Stage Uterine Cancer Survivors. Obstet Gynecol 2016; 127:449-458. [PMID: 26855104 PMCID: PMC4764476 DOI: 10.1097/aog.0000000000001293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the use of periodic surveillance testing for early-stage endometrial cancer survivors. METHODS We performed a population-based analysis using the Surveillance, Epidemiology, and End Results-Medicare database, which was used to identify patients with stage I-II endometrioid endometrial cancer treated from 1992 to 2011. Three surveillance periods (7-18, 19-30, 31-42 months) after hysterectomy were examined. Use of vaginal cytology and imaging were quantified. RESULTS We identified 17,638 patients. From 1992 to 2011, the use of chest radiography decreased (46.3-34.2%) during the first surveillance period, whereas imaging with chest computed tomography (CT) (0.9-12.6%), abdominopelvic CT (11.7-24.8%), and positron emission tomography (0-2.9%) increased (P<.001 for all). The use of cytology increased from 68.5% in 1992 to 72.3% in 2007 and then decreased to 66.9% in 2011 (P=.02). The mean number of cytologic samples obtained per patient increased from 1.3 in 1992 to 1.6 in 2008 and then declined to 1.3 in 2011, whereas the mean per patient number of chest CTs (0.02-0.2), abdominopelvic CTs (0.2-0.4), and positron emission tomographies (0-0.03) rose from 1992 to 2011. In 2011, 49.3% underwent radiologic surveillance 7-18 months after diagnosis, whereas 11.9% underwent two or more radiologic assessments in combination with cytology. These findings were similar for surveillance periods 2 and 3. CONCLUSION The use of chest radiography has decreased and use of cytology has started to decline. However, the use of more costly imaging modalities is increasing despite a lack of evidence for the efficacy of these tests for early-stage endometrial cancer survivors.
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Affiliation(s)
- Jason D. Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
| | - Ana I. Tergas
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
- Department of Epidemiology, Mailman School of Public Health, Columbia University
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
| | - June Y. Hou
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
| | - William M. Burke
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
| | - Jim C. Hu
- Department of Urology, Weill Cornell Medical College
- New York Presbyterian Hospital
| | - Grace Clarke Hillyer
- Department of Epidemiology, Mailman School of Public Health, Columbia University
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
| | - Cande V. Ananth
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | - Alfred I. Neugut
- Department of Medicine, Columbia University College of Physicians and Surgeons
- Department of Epidemiology, Mailman School of Public Health, Columbia University
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
| | - Dawn L. Hershman
- Department of Medicine, Columbia University College of Physicians and Surgeons
- Department of Epidemiology, Mailman School of Public Health, Columbia University
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
- New York Presbyterian Hospital
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Beck TL, Morse CB, Gray HJ, Goff BA, Urban RR, Liao JB. Route of hysterectomy and surgical outcomes from a statewide gynecologic oncology population: is there a role for vaginal hysterectomy? Am J Obstet Gynecol 2016; 214:348.e1-9. [PMID: 26470825 DOI: 10.1016/j.ajog.2015.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/20/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent policy changes by insurance companies have been instituted to encourage vaginal hysterectomy (VH) as the preferred route for removal of the uterus. It is not known if advantages of VH for benign indications apply to women with gynecologic cancer. OBJECTIVE The goal of this study was to assess trends in surgical approach to hysterectomy among gynecologic cancer patients and to evaluate outcomes by approach. We hypothesized that, among gynecologic oncology patients, postoperative complications and hospital stay would differ by surgical approach, and that advantages of VH for benign indications may not apply to gynecologic cancer patients. STUDY DESIGN We performed a population-based retrospective cohort study of cervical, endometrial, or ovarian/fallopian tube cancer patients treated surgically in Washington State from 2004 through 2013 using the Comprehensive Hospital Abstract Reporting System. Surgery was categorized as abdominal hysterectomy (AH), laparoscopic hysterectomy (LH), or VH. We determined rate of surgical approach by year and the association with length of stay, 30-day readmission rate, and perioperative complications. RESULTS We identified 10,117 patients who underwent surgery for gynecologic cancer, with 346 (3.4%) VH, 2698 (26.7%) LH, and 7073 (69.9%) AH. Patients undergoing AH had more comorbidities than patients with VH or LH (Charlson Comorbidity Index ≥2: 11.3%, 7.9%, and 8.1%, respectively; P < .001). From 2004 through 2013 AH and VH declined (94.4-47.9% and 4.4-0.8%, respectively; P < .001) while LH increased from 1.2-51.4% in 2013 (P < .001). Mean length of stay was 4.6 days for women undergoing AH and was 1.9 days shorter for VH (95% confidence interval, 1.6-2.3 days) and 2.6 days shorter for LH (95% confidence interval, 2.4-2.7 days) (P < .001). Risk of 30-day readmission for patients undergoing LH was 40% less likely compared to AH but not different for VH vs AH. CONCLUSION AH and LH remain the preferred routes for hysterectomy in gynecologic oncology. Over the past decade, there has been a significant shift to LH with lower 30-day readmission and complication rates. There may be a limited role for VH in select patients. Current efforts to standardize the surgical approach to hysterectomy should not apply to patients with known or suspected gynecologic cancer.
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Wright JD, Burke WM, Tergas AI, Hou JY, Huang Y, Hu JC, Hillyer GC, Ananth CV, Neugut AI, Hershman DL. Comparative Effectiveness of Minimally Invasive Hysterectomy for Endometrial Cancer. J Clin Oncol 2016; 34:1087-96. [PMID: 26834057 DOI: 10.1200/jco.2015.65.3212] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Despite the potential benefits of minimally invasive hysterectomy for uterine cancer, population-level data describing the procedure's safety in unselected patients are lacking. We examined the use of minimally invasive surgery and the association between the route of the procedure and long-term survival. METHODS We used the SEER-Medicare database to identify women with stage I-III uterine cancer who underwent hysterectomy from 2006 to 2011. Patients who underwent abdominal hysterectomy were compared with those who had minimally invasive hysterectomy (laparoscopic and robot-assisted). Perioperative morbidity, use of adjuvant therapy, and long-term survival were examined after propensity score balancing. RESULTS We identified 6,304 patients, including 4,139 (65.7%) who underwent abdominal hysterectomy and 2,165 (34.3%) who underwent minimally invasive hysterectomy; performance of minimally invasive hysterectomy increased from 9.3% in 2006 to 61.7% in 2011. Robot-assisted procedures accounted for 62.3% of the minimally invasive operations. Compared with women who underwent abdominal hysterectomy, minimally invasive hysterectomy was associated with a lower overall complication rate (22.7% v 39.7%; P < .001), and lower perioperative mortality (0.6% v 1.1%), but these women were more likely to receive adjuvant pelvic radiotherapy (34.3% v 31.3%) and brachytherapy (33.6% v 31.0%; P < .05). The complication rate was higher after robot-assisted hysterectomy compared with laparoscopic hysterectomy (23.7% v 19.5%; P = .03). There was no association between the use of minimally invasive hysterectomy and either overall (HR, 0.89; 95% CI, 0.75 to 1.04) or cancer-specific (HR, 0.83; 95% CI, 0.59 to 1.16) mortality. CONCLUSION Minimally invasive hysterectomy does not appear to compromise long-term survival for women with endometrial cancer.
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Affiliation(s)
- Jason D Wright
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY.
| | - William M Burke
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - Ana I Tergas
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - June Y Hou
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - Yongmei Huang
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - Jim C Hu
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - Grace Clarke Hillyer
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - Cande V Ananth
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - Alfred I Neugut
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - Dawn L Hershman
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
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Abstract
While there is an ongoing debate regarding the timing of the maximal surgical effort in epithelial ovarian cancer, it is well established that patients with suboptimal tumor debulking derive no benefit from the surgical procedure. The amount of residual disease after cytoreductive surgery has been repeatedly identified as a strong predictor of survival, and accordingly, the surgical effort to achieve the goal of complete gross tumor resection has been constantly evolving. Centers that have adopted the concept of radical surgery in patients with advanced ovarian cancer have reported improvements in their patients' survival. In addition to the expected improvements in the pharmacologic treatment of this disease, some of the next challenges in the surgical management of ovarian cancer include the preoperative prediction of suboptimal debulking, improving the drug delivery to the tumor, and increasing access to centers of excellence in ovarian cancer regardless of geographical, financial, or other social barriers. This review will discuss an update on the role of surgery in the treatment of primary epithelial ovarian cancer as it has evolved since the emergence of the concept of surgical cytoreduction.
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Barber EL, Rutstein S, Miller WC, Gehrig PA. A preoperative personalized risk assessment calculator for elderly ovarian cancer patients undergoing primary cytoreductive surgery. Gynecol Oncol 2015; 139:401-6. [PMID: 26432038 PMCID: PMC4679512 DOI: 10.1016/j.ygyno.2015.09.080] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/19/2015] [Accepted: 09/27/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Cytoreductive surgery for ovarian cancer has higher rates of postoperative complication than neoadjuvant chemotherapy followed by surgery. If patients at high risk of postoperative complication were identified preoperatively, primary therapy could be tailored. Our objective was to develop a predictive model to estimate the risk of major postoperative complication after primary cytoreductive surgery among elderly ovarian cancer patients. METHODS Patients who underwent primary surgery for ovarian cancer between 2005 and 2013 were identified from the National Surgical Quality Improvement Project. Patients were selected using primary procedure CPT codes. Major complications were defined as grade 3 or higher complications on the validated Claviden-Dindo scale. Using logistic regression, we identified demographic and clinical characteristics predictive of postoperative complication. RESULTS We identified 2101 ovarian cancer patients of whom 35.9% were older than 65. Among women older than 65, the rate of major postoperative complication was 16.4%. Complications were directly associated with preoperative laboratory values (serum creatinine, platelets, white blood cell count, hematocrit), ascites, white race, and smoking status, and indirectly associated with albumin. Our predictive model had an area under receiver operating characteristic curve of 0.725. In order to not deny patients necessary surgery, we chose a 50% population rate of postoperative complication which produced model sensitivity of 9.8% and specificity of 98%. DISCUSSION Our predictive model uses easily and routinely obtained objective preoperative factors to estimate the risk of postoperative complication among elderly ovarian cancer patients. This information can be used to assess risk, manage postoperative expectations, and make decisions regarding initial treatment.
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Affiliation(s)
- Emma L Barber
- University of North Carolina, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States.
| | - Sarah Rutstein
- University of North Carolina, Department of Health Policy and Management, Gillings School of Public Health, Chapel Hill, NC, United States; University of North Carolina, Division of Infectious Diseases, Department of Internal Medicine, Chapel Hill, NC, United States
| | - William C Miller
- University of North Carolina, Division of Infectious Diseases, Department of Internal Medicine, Chapel Hill, NC, United States; University of North Carolina, Department of Epidemiology, Gillings School of Public Health, Chapel Hill, NC, United States
| | - Paola A Gehrig
- University of North Carolina, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States; Lineberger Clinical Cancer Center, University of North Carolina, Chapel Hill, NC, United States
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Association of Preoperative Thrombocytosis and Leukocytosis With Postoperative Morbidity and Mortality Among Patients With Ovarian Cancer. Obstet Gynecol 2015; 126:1191-1197. [DOI: 10.1097/aog.0000000000001138] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Vidal F, Al Thani H, Haddad P, Luyckx M, Stoeckle E, Morice P, Leblanc E, Lecuru F, Daraï E, Classe JM, Pomel C, Mahfoud Z, Ferron G, Querleu D, Rafii A. Which Surgical Attitude to Choose in the Context of Non-Resectability of Ovarian Carcinomatosis: Beyond Gross Residual Disease Considerations. Ann Surg Oncol 2015; 23:434-42. [PMID: 26542592 DOI: 10.1245/s10434-015-4890-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND In ovarian cancer, the increased rate of radical surgery comprising upper abdominal procedures has participated to improve overall survival (OS) in advanced stages by increasing the rate of complete cytoreductions. However, in the context of non-resectability, it is unclear whether radical surgery should be considered when it would lead to microscopic but visible disease (≤1 cm). We aimed to compare the survival outcomes among patients with incomplete cytoreduction according to the extent of surgery. METHODS Overall, 148 patients presenting with advanced stage ovarian carcinomas were included in this retrospective study, regardless of treatment schedule. These patients were stratified according to the extent of surgery (standard or radical). Complete cytoreduction at the time of debulking surgery could not be carried out in all cases. RESULTS Among our study population (n = 148), 96 patients underwent standard procedures (SPs) and 52 underwent radical surgeries (RP). Patients in the SP group had a lower Peritoneal Index Cancer (PCI) at baseline (12.6 vs. 14.9; p = 0.049). After PCI normalization, we observed similar OS in the SP and RP groups (39.7 vs. 43.1 months; p = 0.737), while patients in the SP group had a higher rate of residual disease >10 mm (p < 10(-3)). Patients in the RP group had an increased rate of relapse (p = 0.005) but no difference in disease-free survival compared with the SP group (22.2 for SP vs. 16.3 months; p = 0.333). Residual disease status did not impact survival outcomes. CONCLUSIONS In the context of non-resectable, advanced stage ovarian cancer, standard surgery seems as beneficial as radical surgery regarding survival outcomes and should be considered to reduce surgery-associated morbidity.
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Affiliation(s)
- Fabien Vidal
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar.,Department of Genetic Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Haya Al Thani
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Pascale Haddad
- Biostatistics Core, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Mathieu Luyckx
- Department of Gynecologic Surgery, Saint Luc Academic Hospital, Catholic University of Louvain, Bruxelles, Belgium
| | - Eberhard Stoeckle
- Comprehensive Cancer Center, Department of Surgery, Institut Bergonie, Bordeaux, France
| | - Philippe Morice
- Department of Gynecologic Surgery, Institut Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France
| | - Eric Leblanc
- Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France
| | - Fabrice Lecuru
- Department of Gynecologic Oncology, Georges Pompidou European Hospital, Paris, France
| | - Emile Daraï
- Department of Gynecologic Surgery, Tenon Hospital, Paris, France
| | - Jean-Marc Classe
- Department of Surgical Oncology, Centre Gauducheau, Comprehensive Cancer Center, Saint Herblain, France
| | - Christophe Pomel
- Department of Surgical Oncology, Jean Perrin Cancer Center, Clermont-Ferrand, France
| | - Ziyad Mahfoud
- Biostatistics Core, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Gwenael Ferron
- Comprehensive Cancer Center, Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Denis Querleu
- Comprehensive Cancer Center, Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Arash Rafii
- Stem Cell and Microenvironment Laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar. .,Department of Genetic Medicine, Weill Cornell Medical College, New York, NY, USA. .,Department of Genetic Medicine and Obstetrics and Gynecology, Weill Cornell Medical College in Qatar, Education City, Doha, Qatar.
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Tewari KS, Java JJ, Eskander RN, Monk BJ, Burger RA. Early initiation of chemotherapy following complete resection of advanced ovarian cancer associated with improved survival: NRG Oncology/Gynecologic Oncology Group study. Ann Oncol 2015; 27:114-21. [PMID: 26487588 DOI: 10.1093/annonc/mdv500] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 10/09/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To determine whether time from surgery to initiation of chemotherapy impacts survival in advanced ovarian carcinoma. PATIENTS AND METHODS This is a post-trial ad hoc analysis of Gynecologic Oncology Group protocol 218, a phase III randomized, double-blind, placebo-controlled trial designed to study the antiangiogenesis agent, bevacizumab, in primary and maintenance therapy for patients with newly diagnosed advanced ovarian carcinoma. Maximum attempt at debulking was an eligibility criterion. Stage III patients, not stage IV, were required to have gross macroscopic or palpable residual disease following surgery. The survival impact of time from surgery to initiation of chemotherapy was studied using Cox regression models and stratified by treatment arm, residual disease and other clinical and pathologic factors. RESULTS One thousand seven hundred eighteen assessable patients were randomized (stage III (n = 1237); stage IV (n = 477), including those with complete resection (stage IV only, n = 81), low-volume residual (≤1 cm, n = 701), and suboptimal (>1 cm, n = 932). On multivariate analysis, time to chemotherapy initiation was predictive of overall survival (P < 0.001), with the complete resection group (i.e. stage IV) encountering an increased risk of death when time to initiation of chemotherapy exceeded 25 days (95% confidence interval 16.6-49.9 days). CONCLUSION Survival for women with advanced ovarian cancer may be adversely affected when initiation of chemotherapy occurs >25 days following surgery. Our analysis applies to stage IV only as women with stage III who underwent complete resection were not eligible for this trial. These results, however, are consistent with Gompertzian first-order kinetics where patients with microscopic residual are most vulnerable. CLINICAL TRIALS IDENTIFIER NCT00262847.
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Affiliation(s)
- K S Tewari
- University of California, Irvine Medical Center, Orange, California
| | - J J Java
- NRG Oncology/Gynecologic Oncology Group Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo
| | - R N Eskander
- University of California, Irvine Medical Center, Orange, California
| | - B J Monk
- Creighton University School of Medicine, St Joseph's Hospital and Medical Center, Phoenix
| | - R A Burger
- Obstetrics and Gynecology, University of Pennsylvania, Pennsylvania, USA
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Impact of Age on 30-Day Mortality and Morbidity in Patients Undergoing Surgery for Ovarian Cancer. Int J Gynecol Cancer 2015; 25:1216-23. [DOI: 10.1097/igc.0000000000000486] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
ObjectiveTo examine the effect of age on postoperative 30-day morbidity and mortality after surgery for ovarian cancer.MethodsThe American College of Surgeons National Surgical Quality Improvement Program files were used to identify patients with ovarian cancer who underwent surgery in 2005 to 2011. Women were divided into 4 age groups: <60, 60 to 69, 70 to 79, and ≥80 years. Multivariable logistic regression models were performed.ResultsOf 2087 patients included, 47% were younger than 60 years, 28% were 60 to 69 years old, 18% were 70 to 79 years old, and 7% were 80 years or older. Overall 30-day mortality and morbidity rates were 2% and 30%. Elderly patients 80 years or older were more likely to die within 30 days compared with patients younger than 60 years, 60 to 69 years old, and 70 to 79 years old (9.2% vs. 0.6% vs .2.8% vs 2.5%, P < 0.001). Elderly patient aged 80 years or older were more likely to develop pulmonary (9% vs 2% vs 5% vs 3%, P < 0.001) and septic (9% vs 3% vs 5% vs 4%, P = 0.01) complications compared with patients younger than 60 years, 60 to 69 years old, and 70 to 79 years old, respectively. No difference in the risk of renal (0.2% vs 1% vs 1% vs 1%, P = 0.20) complications and surgical reexploration (4% vs 4% vs 3% vs 5%, P = 0.80) between the 4 age groups. In multivariable analyses after adjusting for other confounders, age was a significant predictor of 30-day postoperative mortality and morbidity. Compared with younger patients, octogenarians were 9-times more likely to die and 70% more likely to develop complications within 30 days after surgery. Other significant predictors of 30-day mortality were higher American Society of Anesthesiologists class and hypoalbuminemia (serum albumin ≤ 3 g/dL), whereas, surgical complexity, higher American Society of Anesthesiologists class, longer operative time, and hypoalbuminemia were other significant predictors of 30-day morbidity.ConclusionsElderly patients have a higher risk of perioperative mortality and morbidity within 30 days. Therefore, those patients should be counseled thoroughly about the risk of primary debulking surgery vs neoadjuvant chemotherapy.
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Wright AA, Cronin A, Milne DE, Bookman MA, Burger RA, Cohn DE, Cristea MC, Griggs JJ, Keating NL, Levenback CF, Mantia-Smaldone G, Matulonis UA, Meyer LA, Niland JC, Weeks JC, O'Malley DM. Use and Effectiveness of Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer. J Clin Oncol 2015; 33:2841-7. [PMID: 26240233 DOI: 10.1200/jco.2015.61.4776] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A 2006 randomized trial demonstrated a 16-month survival benefit with intraperitoneal and intravenous (IP/IV) chemotherapy administered to patients who had ovarian cancer, compared with IV chemotherapy alone, but more treatment-related toxicities. The objective of this study was to examine the use and effectiveness of IP/IV chemotherapy in clinical practice. PATIENTS AND METHODS Prospective cohort study of 823 women with stage III, optimally cytoreduced ovarian cancer diagnosed at six National Comprehensive Cancer Network institutions. We examined IP/IV chemotherapy use in all patients diagnosed between 2003 and 2012 (N = 823), and overall survival and treatment-related toxicities with Cox regression and logistic regression, respectively, in a propensity score-matched sample (n = 402) of patients diagnosed from 2006 to 2012, excluding trial participants, to minimize selection bias. RESULTS Use of IP/IV chemotherapy increased from 0% to 33% between 2003 and 2006, increased to 50% from 2007 to 2008, and plateaued thereafter. Between 2006 and 2012, adoption of IP/IV chemotherapy varied by institution from 4% to 67% (P < .001) and 43% of patients received modified IP/IV regimens at treatment initiation. In the propensity score-matched sample, IP/IV chemotherapy was associated with significantly improved overall survival (3-year overall survival, 81% v 71%; hazard ratio, 0.68; 95% CI, 0.47 to 0.99), compared with IV chemotherapy, but also more frequent alterations in chemotherapy delivery route (adjusted rates discontinuation or change, 20.4% v 10.0%; adjusted odds ratio, 2.83; 95% CI, 1.47 to 5.47). CONCLUSION Although the use of IP/IV chemotherapy increased significantly at National Comprehensive Cancer Network centers between 2003 and 2012, fewer than 50% of eligible patients received it. Increasing IP/IV chemotherapy use in clinical practice may be an important and underused strategy to improve ovarian cancer outcomes.
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Affiliation(s)
- Alexi A Wright
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Angel Cronin
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dana E Milne
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael A Bookman
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert A Burger
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David E Cohn
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mihaela C Cristea
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer J Griggs
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nancy L Keating
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles F Levenback
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gina Mantia-Smaldone
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ursula A Matulonis
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Larissa A Meyer
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joyce C Niland
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane C Weeks
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David M O'Malley
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
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Patankar S, Burke WM, Hou JY, Tergas AI, Huang Y, Ananth CV, Neugut AI, Hershman DL, Wright JD. Risk stratification and outcomes of women undergoing surgery for ovarian cancer. Gynecol Oncol 2015; 138:62-9. [PMID: 25976399 PMCID: PMC4469531 DOI: 10.1016/j.ygyno.2015.04.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Cytoreduction for ovarian cancer is associated with substantial morbidity. We examined the outcome of patients undergoing surgery for ovarian cancer to determine if there are sub-groups of patients who may benefit from alternative treatments. METHODS The National Surgical Quality Improvement Program database was used to identify women who underwent surgery for ovarian cancer from 2005-2012. Multivariable logistic regression models were used to examine the effect of age, race, functional status, ASA class, preoperative albumin and performance of extended cytoreductive procedures on morbidity, mortality and resource utilization. RESULTS A total of 2870 women were identified. The perioperative complication rate increased from 9.5% in women <50years, to 13.4% in those age 60-69years, and 14.6% in women ≥70years (P<0.0001). Similarly, complications rose from 7.3% in those who did not require any extended procedures to 12.9% after 1 procedure, 28.4% for those who had 2, and 30.0% in women who underwent ≥3 extended procedures (P<0.0001). In a series of multivariable models, the number of extended cytoreductive procedures performed and preoperative albumin were the factors most consistently associated with morbidity. Using a series of model fit statistics, compared to chance alone, the ability to predict any complication increased by 27.4% when procedure score was analyzed, 22.0% with preoperative albumin, 11% with age, and 4% with functional status. CONCLUSIONS While preoperative clinical and demographic factors may help predict the risk of adverse outcomes for women undergoing surgery for ovarian cancer, performance of extended cytoreductive procedures is the strongest risk factor for complications.
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Affiliation(s)
- Sonali Patankar
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA
| | - William M Burke
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - June Y Hou
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Ana I Tergas
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA
| | - Alfred I Neugut
- Department of Medicine, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Dawn L Hershman
- Department of Medicine, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA.
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Anuradha S, Donovan PJ, Webb PM, Brand AH, Goh J, Friedlander M, Oehler MK, Quinn M, Steer C, Jordan SJ. Variations in adjuvant chemotherapy and survival in women with epithelial ovarian cancer - a population-based study. Acta Oncol 2015; 55:226-33. [PMID: 26079434 DOI: 10.3109/0284186x.2015.1054950] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To investigate whether variations in primary chemotherapy were associated with survival in a nationally complete cohort of Australian women with epithelial ovarian cancer (EOC). MATERIAL AND METHODS All 1192 women diagnosed with invasive EOC in Australia in 2005 were identified through state-based cancer registries. Medical record information including details of primary chemotherapy treatment was obtained and survival data updated in 2012. Those started on standard chemotherapy (carboplatin and paclitaxel given at three-weekly intervals) after primary cytoreductive surgery were included (n = 351) and the relative dose intensity (RDI) was calculated. Time interval between surgery and start of chemotherapy was analysed in weeks. Hazard ratios [HR, 95% confidence interval (CI)] were calculated using multivariable Cox proportional hazards models. RESULTS Compared to women with RDI of 91-100%, those with RDI of ≤ 70% had significantly poor survival (HRadj = 1.62, 95% CI 1.05-2.49). This association was stronger among women with advanced (FIGO stage III/IV) disease at diagnosis (HRadj = 1.90, 95% CI 1.22-2.96). The interval between primary surgery and chemotherapy was not related to survival (HRadj = 0.98, 95% CI 0.93-1.03 for every week of delay), at least up to a period of five weeks. CONCLUSION Our results suggest that RDI of 70% or less was associated with poorer survival, particularly in women with advanced stage EOC. In contrast, the interval duration between primary surgery and chemotherapy was not related to survival, irrespective of disease stage or residual disease. These results provide some reassurance that, at least up until five weeks post-surgery, timing of chemotherapy commencement has a negligible effect on survival.
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Affiliation(s)
- Satyamurthy Anuradha
- a The University of Queensland, School of Public Health , Brisbane , Queensland , Australia
- b The QIMR Berghofer Medical Research Institute, Gynaecological Cancers Group , Brisbane , Queensland , Australia
| | - Peter J Donovan
- b The QIMR Berghofer Medical Research Institute, Gynaecological Cancers Group , Brisbane , Queensland , Australia
| | - Penelope M Webb
- b The QIMR Berghofer Medical Research Institute, Gynaecological Cancers Group , Brisbane , Queensland , Australia
| | - Alison H Brand
- c Department of Gynaecological Oncology , Westmead Hospital, University of Sydney , Westmead, New South Wales , Australia
| | - Jeffrey Goh
- d Royal Brisbane and Women's Hospital , Brisbane , Queensland , Australia
| | - Michael Friedlander
- e Department of Medical Oncology , Prince of Wales Hospital , Sydney , New South Wales , Australia
| | - Martin K Oehler
- f Department of Gynaecological Oncology , Royal Adelaide Hospital , Adelaide , South Australia , Australia
| | - Michael Quinn
- g Department of Obstetrics and Gynaecology University of Melbourne , Melbourne , Victoria , Australia
| | | | - Susan J Jordan
- b The QIMR Berghofer Medical Research Institute, Gynaecological Cancers Group , Brisbane , Queensland , Australia
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Duska LR, Tew WP, Moore KN. Epithelial ovarian cancer in older women: defining the best management approach. Am Soc Clin Oncol Educ Book 2015:e311-21. [PMID: 25993191 DOI: 10.14694/edbook_am.2015.35.e311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Epithelial ovarian cancer is a cancer of older women. In fact, almost half of women diagnosed with ovarian cancer will be older than age 64, and 25% will be older than age 74. Therefore, it is crucial to examine the available data in older populations to optimize the therapeutic approach without negatively affecting the quality of life permanently. Unfortunately, little prospective data are available in this under-represented population of women. Although ovarian cancer traditionally has been approached with aggressive cytoreductive surgery, older patients may benefit from a less aggressive surgical approach and, in some cases, may be candidates for neoadjuvant chemotherapy followed by an interval cytoreduction. Modalities do exist for assessing an older woman's ability to tolerate surgery and chemotherapy, and these tools should be familiar to clinicians who are caring for this population of women in making treatment decisions. Ongoing planned trials to evaluate pretreatment assessment for older patients will provide objective, feasible, clinical tools for applying our treatment-based knowledge. Future trials of both surgery and chemotherapy, including a focus on the sequence of these two treatment modalities, are crucial to guide decision making in this vulnerable population and to improve outcomes for all.
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Affiliation(s)
- Linda R Duska
- From the University of Virginia, Charlottesville, VA; Memorial Sloan Kettering Cancer Center, New York NY; University of Oklahoma, Oklahoma City, OK
| | - William P Tew
- From the University of Virginia, Charlottesville, VA; Memorial Sloan Kettering Cancer Center, New York NY; University of Oklahoma, Oklahoma City, OK
| | - Kathleen N Moore
- From the University of Virginia, Charlottesville, VA; Memorial Sloan Kettering Cancer Center, New York NY; University of Oklahoma, Oklahoma City, OK
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Dinkelspiel HE, Tergas AI, Zimmerman LA, Burke WM, Hou JY, Chen L, Hillyer G, Neugut AI, Hershman DL, Wright JD. Use and duration of chemotherapy and its impact on survival in early-stage ovarian cancer. Gynecol Oncol 2015; 137:203-9. [PMID: 25703674 DOI: 10.1016/j.ygyno.2015.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/13/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Although 5-year survival for early-stage ovarian cancer is favorable, prognosis at recurrence is poor, necessitating appropriate initial management. We examined the patterns of care and the impact of the duration of chemotherapy on survival for women with early-stage ovarian cancer. METHODS We used the SEER-Medicare database to identify women ≥ 65 years of age with stage I ovarian cancer diagnosed from 1992 to 2009. Patients were categorized as low-risk (non-clear cell histology, stage IA or IB, grade 1 or 2) or high-risk (clear cell histology, grade 3, or stage IC). We used multivariable logistic regression models to determine predictors of chemotherapy use and duration and Cox proportional hazards models to evaluate the effect of chemotherapy use and duration on survival. RESULTS We identified 1394 patients. Among low-risk patients, 32.9% received adjuvant chemotherapy and the use of chemotherapy increased with time. Among high-risk patients, 71.9% received adjuvant chemotherapy; 44.2% had ≤ 3 months of treatment, and 55.8% had > 3 months of treatment. Older patients were less likely to receive chemotherapy, while those with higher stage and grade were more likely to receive chemotherapy (P<0.05 for all). Among high-risk patients, the duration of chemotherapy did not impact overall (HR=0.93, 95% CI, 0.67-1.27) or cancer specific (HR=0.93; 95% CI, 0.61-1.42) survival. CONCLUSIONS Among early-stage ovarian cancer patients, practice patterns are widely divergent. Extended duration chemotherapy does not appear to impact survival for women with high-risk disease.
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Affiliation(s)
- Helen E Dinkelspiel
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA
| | - Ana I Tergas
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Lilli A Zimmerman
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA
| | - William M Burke
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - June Y Hou
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Ling Chen
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA
| | - Grace Hillyer
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, USA
| | - Alfred I Neugut
- Department of Medicine, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Dawn L Hershman
- Department of Medicine, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA.
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Comparative effectiveness research in gynecologic oncology. Cancer Treat Res 2015; 164:237-59. [PMID: 25677027 PMCID: PMC4484275 DOI: 10.1007/978-3-319-12553-4_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The field of gynecologic oncology is faced with a number of challenges including how to incorporate new drugs and procedures into practice, how to balance therapeutic efficacy and toxicity of treatment, how to individualize therapy to particular patients or groups of patients, and how to contain the rapidly rising costs associated with oncologic care. In this chapter we examine three common and highly debated clinical scenarios in gynecologic oncology: the initial management of ovarian cancer, the role of lymphadenectomy in the treatment of endometrial cancer, and the choice of adjuvant therapy for ovarian cancer.
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69
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Tew WP, Fleming GF. Treatment of ovarian cancer in the older woman. Gynecol Oncol 2015; 136:136-42. [DOI: 10.1016/j.ygyno.2014.10.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 10/21/2014] [Accepted: 10/28/2014] [Indexed: 01/05/2023]
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70
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Gunderson CC, Thomas ED, Slaughter KN, Farrell R, Ding K, Farris RE, Lauer JK, Perry LJ, McMeekin DS, Moore KN. The survival detriment of venous thromboembolism with epithelial ovarian cancer. Gynecol Oncol 2014; 134:73-7. [DOI: 10.1016/j.ygyno.2014.04.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 11/25/2022]
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Doll KM, Snavely AC, Kalinowski A, Irwin DE, Bensen JT, Bae-Jump V, Boggess JF, Soper JT, Brewster WR, Gehrig PA. Preoperative quality of life and surgical outcomes in gynecologic oncology patients: a new predictor of operative risk? Gynecol Oncol 2014; 133:546-51. [PMID: 24726615 DOI: 10.1016/j.ygyno.2014.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/01/2014] [Accepted: 04/02/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Quality of life (QoL) for women with gynecologic malignancies is predictive of chemotherapy related toxicity and overall survival but has not been studied in relation to surgical outcomes and hospital readmissions. Our goal was to evaluate the association between baseline, pre-operative QoL measures and 30-day post-operative morbidity and health resource utilization by gynecologic oncology patients. METHODS We analyzed prospectively collected survey data from an institution-wide cohort study. Patients were enrolled from 8/2012 to 6/2013 and medical record data was abstracted (demographics, comorbid conditions, and operative outcomes). Responses from several validated health-related QoL instruments were collected. Bivariate tests and multivariable linear and logistic regression models were used to evaluate factors associated with QoL scores. RESULTS Of 182 women with suspected gynecologic malignancies, 152 (84%) were surveyed pre-operatively and 148 (81%) underwent surgery. Uterine (94; 63.5%), ovarian (26; 17.5%), cervical (15; 10%), vulvar/vaginal (8; 5.4%), and other (5; 3.4%) cancers were represented. There were 37 (25%) cases of postoperative morbidity (PM), 18 (12%) unplanned ER visits, 9(6%) unplanned clinic visits, and 17 (11.5%) hospital readmissions (HR) within 30days of surgery. On adjusted analysis, lower functional well-being scores resulted in increased odds of PM (OR 1.07, 95%CI 1.01-.1.21) and HR (OR 1.11, 95%CI 1.03-1.19). A subjective global assessment score was also strongly associated with HR (OR 1.89, 95%CI 1.14, 3.16). CONCLUSION Lower pre-operative QoL scores are significantly associated with post-operative morbidity and hospital readmission in gynecologic cancer patients. This relationship may be a novel indicator of operative risk.
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Affiliation(s)
- K M Doll
- Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Cancer Care Quality Training Program, Division of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - A C Snavely
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - A Kalinowski
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - D E Irwin
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - J T Bensen
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - V Bae-Jump
- Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - J F Boggess
- Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - J T Soper
- Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - W R Brewster
- Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - P A Gehrig
- Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Pölcher M, Zivanovic O, Chi DS. Cytoreductive Surgery for Advanced Ovarian Cancer. WOMENS HEALTH 2014; 10:179-90. [DOI: 10.2217/whe.14.4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The amount of the largest diameter of visible residual tumor after cytoreductive surgery remains one of the strongest prognostic factors In advanced ovarian cancer. The Implementation of a more aggressive surgical approach to Increase the proportion of patients without visible residual tumor Is, therefore, a rational concept. Thus, the surgical management of advanced ovarian, primary peritoneal and fallopian tube cancers now Incorporates more comprehensive surgical procedures. However, these more extensive surgical procedures are associated with an Increased risk of morbidity, which may have a negative Impact on the oncologic outcome. In addition, It Is unclear whether all patients benefit from a comprehensive surgical Intervention In the same way or If there are patients whose disease course will not be Influenced by this approach. The methodologic analysis of surgical effectiveness Is complex and controversial owing to a lack of prospective surgical trials. This review acknowledges controversies and alms to discuss novel developments In the field of cytoreductive surgery for patients with ovarian, primary peritoneal and fallopian tube cancers. The focus of the review Is to discuss the role of surgery at Initial diagnosis. The role of secondary and tertiary surgery In the recurrent setting Is beyond the scope of this review.
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Affiliation(s)
- Martin Pölcher
- Red Cross Women's Hospital Munich, Department of Gynecologic Oncology & Minimally-Invasive Surgery, Munich, Germany
| | - Oliver Zivanovic
- Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Dennis S Chi
- Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Wright JD, Ananth CV, Tsui J, Glied SA, Burke WM, Lu YS, Neugut AI, Herzog TJ, Hershman DL. Comparative effectiveness of upfront treatment strategies in elderly women with ovarian cancer. Cancer 2014; 120:1246-54. [PMID: 24443159 DOI: 10.1002/cncr.28508] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 11/03/2013] [Accepted: 11/05/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Observational studies comparing neoadjuvant chemotherapy to primary surgery for advanced-stage ovarian cancer are limited by strong selection bias. Multiple methods were used to control for confounding and selection bias to estimate the effect of primary treatment on survival for ovarian cancer. METHODS The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify women ≥ 65 years of age with stage II-IV epithelial ovarian cancer who survived > 6 months from the date of diagnosis and received treatment from 1991 through 2007. Traditional regression analysis, propensity score-based analysis, and an instrumental variable analysis (IVA) using geographic location as an instrument were used to compare survival between neoadjuvant chemotherapy and primary surgery. RESULTS A total of 9587 patients with stage II-IV ovarian cancer were identified. Use of primary surgery decreased from 63.2% in 1991 to 49.5% by 2007, whereas primary chemotherapy increased from 19.7% in 1991 to 31.8% in 2007 (P < .0001). In the observational cohort survival (hazard ratio [HR] = 1.27; 95% confidence interval [CI] = 1.19-1.35) was inferior for patients treated with neoadjuvant chemotherapy; both median survival (15.8 versus 28.8 months) and 2-year survival (36% versus 56%) were lower in the neoadjuvant chemotherapy group compared to those who underwent surgery. In the IVA, primary treatment had minimal effect on overall survival (HR = 1.04; 95% CI = 0.67-1.60). The median survival for patients with a value of the instrument less than the median (24.0 months, 95% CI = 23.0-25.0) and greater than or equal to median value of the IV (24.0 months, 95% CI = 23.0-26.0) were similar. CONCLUSIONS Use of neoadjuvant therapy has increased over time. Survival with neoadjuvant chemotherapy did not differ significantly from primary surgery in elderly women in the United States.
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Affiliation(s)
- Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
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Hacker N. State of the art of surgery in advanced epithelial ovarian cancer. Ann Oncol 2013; 24 Suppl 10:x27-32. [DOI: 10.1093/annonc/mdt465] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Failure to rescue after major gynecologic surgery. Am J Obstet Gynecol 2013; 209:420.e1-8. [PMID: 23933221 DOI: 10.1016/j.ajog.2013.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/23/2013] [Accepted: 08/05/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE There is growing recognition that, in addition to occurrence of perioperative complications, the treatment of patients with complications influences outcome. We examined complications, failure to rescue (death in patients with a complication), and mortality rates for women who underwent abdominal hysterectomy. STUDY DESIGN Women who underwent abdominal hysterectomy from 1998-2010 and whose data were recorded in the Nationwide Inpatient Sample were identified. Hospitals were stratified based on risk-adjusted mortality rates into 5 quintiles, and rates of complications and failure to rescue were examined. RESULTS A total of 664,229 women who had been treated at 741 hospitals were identified. The overall mortality rate for the cohort was 0.17%. The risk-adjusted, hospital-level mortality rate ranged from 0-1.12%. The complication rate was 6.5% at the hospitals with the lowest mortality rates, 9.9% at the second quintile hospitals, 9.5% at both the third and fourth quintile hospitals, and 7.9% at the hospitals with the highest mortality rates. In contrast to complications, the failure-to-rescue rate increased with each successive risk-adjusted mortality quintile. The failure-to-rescue rate was 0% at the hospitals with the lowest mortality rates and increased with each successive quintile to 1.1%, 2.1%, 2.7%, and 4.4% in the hospitals with the highest mortality rates (P < .0001). CONCLUSION For women who underwent abdominal hysterectomy, hospital complication rates correlated poorly with mortality rates; failure-to-rescue is strongly associated with in-hospital mortality rates. The treatment of complications, not the actual development of a complication, is the most important factor to use to predict death after major gynecologic surgery.
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The time interval from surgery to start of chemotherapy significantly impacts prognosis in patients with advanced serous ovarian carcinoma — Analysis of patient data in the prospective OVCAD study. Gynecol Oncol 2013; 131:15-20. [DOI: 10.1016/j.ygyno.2013.07.086] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/09/2013] [Accepted: 07/15/2013] [Indexed: 11/23/2022]
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