title: Is it possible to define an optimal time for chemotherapy after surgery for ovarian cancer?
abstract: OBJECTIVE
  The aims of this study are to investigate the actual time from primary surgery for epithelial ovarian cancer (OC) to initiation of chemotherapy (TI) amongst Danish women in 2005-2006, and to compare the survival for groups with early initiation (≤median TI) and late initiation of adjuvant chemotherapy (>median TI).
  
  
  METHODS
  All Danish women who underwent surgery for OC in the period 1 January 2005 to 31 December 2006 and recorded in the Danish Gynaecological Cancer Database (DGCD) were included. The five-year survival was estimated overall and by TI exposure. The Cox proportional hazard regression analysis was used to compute the adjusted hazard ratio (HR).
  
  
  RESULTS
  The median TI was 32days (25-75% quartile: 24days; 41days). The strongest prognostic factors for death were residual tumour and the International Federation of Obstetrics and Gynecology (FIGO) stage. The unadjusted HR for death in patients with TI>32days compared with TI≤32days was 0.85 (95% CI: 0.70; 1.04), p-value 0.12. When adjusted for residual tumour and FIGO-stage the HR was 1.13 (95% CI: 0.92; 1.39), p-value 0.26. The overall five-year survival was 42.8%, (95% CI: 38.9%; 46.5%).
  
  
  CONCLUSIONS
  This nationwide population-based cohort study revealed a non-significant increased risk of death for patients with TI>32days compared with the reference TI≤32days. The strongest prognostic factors were residual tumour after surgery and FIGO-stage. The overall five-year survival was 42.8% (95% CI: 38.9%; 46.5%).
authors.affiliation: Department of Gynaecology and Obstetrics, Aarhus University Hospital, Denmark. Electronic address: lisbethlydiksen@ki.au.dk.
authors.forename: L
authors.initials: L
authors.lastname: Lydiksen
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Denmark. Electronic address: soejense@rm.dk.
authors.forename: S
authors.initials: S
authors.lastname: Jensen-Fangel
authors.affiliation: Department of Gynaecology and Obstetrics, Aarhus University Hospital, Denmark. Electronic address: jab@dadlnet.dk.
authors.forename: J
authors.initials: J
authors.lastname: Blaakaer
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018269:Carcinoma, Endometrioid / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D015331:Cohort Studies; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D016208:Databases, Factual; D003718:Denmark; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chemotherapy; Ovarian cancer; Prognosis; Surgery; Survival; Time interval