What is the optimal treatment for obese patients with advanced ovarian carcinoma?
OBJECTIVE
The purpose of this study was to compare primary debulking surgery (PDS) vs neoadjuvant chemotherapy with interval debulking surgery (NACT-IDS) among obese patients.


METHODS
Medical records of patients with a body mass index (BMI) of ≥30 kg/m(2) with ovarian/fallopian tube/primary peritoneal carcinoma between January 2005 and December 2010 were reviewed. Patients were separated by PDS or NACT-IDS. Preoperative characteristics, surgical procedures, and postoperative and oncologic outcomes were compared.


RESULTS
Of 117 patients, 95 women (81.2%) underwent PDS, and 22 women (18.8%) underwent NACT-IDS. Patients who underwent NACT-IDS were more likely to have stage IV disease (63.6% vs 26.3%; P = .001) and a low surgical complexity score (n = 14; 63.6%). There were no other differences between groups with respect to preoperative characteristics or postoperative morbidity. Compared with the NACT-IDS group, the PDS group had an improved progression-free survival (PFS; 15 vs 11 months; P = .006) and overall survival (OS; 53 vs 32 months; P = .036). Seventy-eight patients (66.7%) had a BMI of 30-34.9 kg/m(2). Within this subset of obese patients, the PDS group had an improved PFS (15 vs 10 months; P = .011) and OS (58 vs 32 months; P = .033), compared with the NACT-IDS group. Among patients with a BMI of ≥35 kg/m(2), there was no difference in PFS (14 vs 12 months; P = .316) or OS (38 vs 32 months; P = .640) when the PDS and NACT-IDS groups were compared.


CONCLUSIONS
Patients with a BMI of 30-34.9 kg/m(2) who undergo PDS have improved oncologic outcomes, compared with those women who undergo NACT-IDS. Patients with a BMI of ≥35 kg/m(2) who undergo PDS have similar oncologic outcomes to those who undergo NACT-IDS. Complication rates were similar at all BMIs, regardless of treatment approach.
Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA.
Michael J
MJ
Worley
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
Stephanie H
SH
Guseh
Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA.
J Alejandro
JA
Rauh-Hain
Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA.
Katharine M
KM
Esselen
Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA.
Michael G
MG
Muto
Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA.
Colleen M
CM
Feltmate
Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA.
Ross S
RS
Berkowitz
Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA.
Marcela G
MG
Del Carmen
Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA.
John O
JO
Schorge
Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA. Electronic address: nhorowitz@partners.org.
Neil S
NS
Horowitz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications*; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*
neoadjuvant chemotherapy; obesity; ovarian cancer; primary debulking surgery