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.
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 (<or=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.


CONCLUSIONS
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.
Zivanovic
Oliver
O
Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Sima
Camelia S
CS
Iasonos
Alexia
A
Hoskins
William J
WJ
Pingle
Pavani R
PR
Leitao
Mario M M
MM
Sonoda
Yukio
Y
Abu-Rustum
Nadeem R
NR
Barakat
Richard R
RR
Chi
Dennis S
DS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009852:Omentum / Q000473:pathology* / Q000601:surgery*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000473:pathology* / Q000601:surgery*; D016016:Proportional Hazards Models; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds