title: Influence of interval between primary surgery and chemotherapy on short-term survival of patients with advanced ovarian, tubal or peritoneal cancer.
abstract: OBJECTIVE
  To investigate the impact on short-term survival of time between surgery and start of first chemotherapy cycle in patients with advanced ovarian cancer.
  
  
  METHODS
  This prospective, population-based study comprised 371 patients with epithelial ovarian, tubal or peritoneal cancer diagnosed in 2002-2003. All patients underwent primary surgery, followed at different intervals by chemotherapy. The data were derived from notifications to the Norwegian Cancer Registry and included medical, surgical and histopathological records. Kaplan-Meier plots were used to show differences in survival, and Cox regression analysis was used to show the effect of prognostic factors on survival, expressed as hazard ratios (HRs).
  
  
  RESULTS
  No difference in survival between patient groups was seen when time between surgery and start of chemotherapy was divided into quartiles. The group of patients with no residual disease and an interval between surgery and start of chemotherapy equal to or more than 6 weeks had non-significantly worse survival (unadjusted HR = 1.86; adjusted HR = 1.35) than those with an interval of less than 6 weeks. Patients with residual disease after surgery and chemotherapy at an interval of less than 6 weeks had worse short-term survival than patients without residual disease and the same interval before chemotherapy: unadjusted HR = 3.66 (95% CI, 2.09-6.40) and adjusted HR = 2.36 (95% CI, 1.22-4.57).
  
  
  CONCLUSIONS
  The interval between surgery and start of chemotherapy had no major impact on short-term survival after ovarian cancer. Patients might be included in chemotherapy trials when interval between surgery and start of chemotherapy is more than 6 weeks. Any further investigation of a possible effect of interval between surgery and start of chemotherapy should be performed as a randomized trial.
authors.affiliation: The Cancer Registry of Norway, Montebello, N-0310 Oslo, Norway. torbjorn_paulsen@hotmail.com
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Paulsen
authors.forename: Janne
authors.initials: J
authors.lastname: Kaern
authors.forename: Kristina
authors.initials: K
authors.lastname: Kjaerheim
authors.forename: Tor
authors.initials: T
authors.lastname: Haldorsen
authors.forename: Claes
authors.initials: C
authors.lastname: Tropé
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005185:Fallopian Tube Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis