title: 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.
abstract: OBJECTIVE
  Cytoreductive surgery and platinum-based systemic therapy constitute the standard treatment of patients with advanced ovarian cancer. The aim of the present study was to evaluate whether the time interval from surgery to start of chemotherapy has an impact on clinical outcome.
  
  
  METHODS
  Data of 191 patients with advanced serous (FIGO III-IV) ovarian cancer from the prospective multicenter study OVCAD (OVarian CAncer Diagnosis) were analyzed. All patients underwent primary surgery followed by platinum-based chemotherapy.
  
  
  RESULTS
  The 25%, 50%, and 75% quartiles of intervals from surgery to start of chemotherapy were 22, 28, and 38 days, respectively (range, 4-158 days). Preoperative performance status (P<0.001), extent of surgery (P<0.001), and perioperative complications (P<0.001) correlated with intervals from surgery to initiation of chemotherapy. Timing of cytotoxic treatment [≤ 28 days versus >28 days; hazard ratio (HR) 1.73 (95% confidence interval 1.08-2.78), P=0.022], residual disease [HR 2.95 (95% confidence interval 1.87-4.67), P<0.001], and FIGO stage [HR 2.26 (95% confidence interval 1.41-3.64), P=0.001] were significant prognostic factors for overall survival in multivariate analysis. While the interval from surgery to start of chemotherapy did not possess prognostic significance in patients without postoperative residual disease (n=121), it significantly correlated with overall survival in patients with postoperative residual disease [n=70, HR 2.24 (95% confidence interval 1.08-4.66), P=0.031].
  
  
  CONCLUSIONS
  Our findings suggest that delayed initiation of chemotherapy might compromise overall survival in patients with advanced serous ovarian cancer, especially when suboptimally debulked.
authors.affiliation: Department of Gynecology and Obstetrics, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Hofstetter
authors.forename: N
authors.initials: N
authors.lastname: Concin
authors.forename: I
authors.initials: I
authors.lastname: Braicu
authors.forename: R
authors.initials: R
authors.lastname: Chekerov
authors.forename: J
authors.initials: J
authors.lastname: Sehouli
authors.forename: I
authors.initials: I
authors.lastname: Cadron
authors.forename: T
authors.initials: T
authors.lastname: Van Gorp
authors.forename: F
authors.initials: F
authors.lastname: Trillsch
authors.forename: S
authors.initials: S
authors.lastname: Mahner
authors.forename: H
authors.initials: H
authors.lastname: Ulmer
authors.forename: C
authors.initials: C
authors.lastname: Grimm
authors.forename: D Cacsire
authors.initials: DC
authors.lastname: Castillo-Tong
authors.forename: R
authors.initials: R
authors.lastname: Zeillinger
authors.forename: A G
authors.initials: AG
authors.lastname: Zeimet
authors.forename: I
authors.initials: I
authors.lastname: Vergote
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D016016:Proportional Hazards Models; D015996:Survival Rate; D013997:Time Factors; D061665:Time-to-Treatment
keywords: Ovarian cancer; Prognosis; Timing of chemotherapy