Influence of intraperitoneal dissemination assessed by laparoscopy on prognosis of advanced ovarian cancer: an exploratory analysis of a single-institution experience.
OBJECTIVE
The aim of this study was to investigate whether preoperative laparoscopic evaluation of the dissemination of disease may have an independent impact on survival in advanced epithelial ovarian cancer (AEOC).


METHODS
All AEOC women were submitted to staging laparoscopy before receiving primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT). All study women received a laparoscopic score (predictive index value [PIV]) and were stratified into three groups based on volume of disease: high tumor load (HTL) for PIV ≥8, intermediate tumor load (ITL) for PIV equal to 6 and 4, and low tumor load (LTL) for PIV <4. Surgical and survival outcome were evaluated by univariate and multivariate analysis.


RESULTS
Among 348 consecutive patients, almost half (48.0 %) had an HTL. Among 165 cases receiving PDS, residual tumor (RT) was as follows: no gross residual in 102 patients (61.8 %); RT ≤1 cm in 48 patients (29.1 %) and RT >1 cm in 15 cases (9.1 %). When stratifying the whole population according to laparoscopic tumor load, the median progression-free survival (PFS) was 33 months for LTL, 18 months for ITL, and 14 months for HTL (p = 0.0001). The median overall survival (OS) with respect to laparoscopic PIV was not reached for LTL, whereas it was 47 months for ITL and 33 months for HTL, respectively (p = 0.0001). At multivariate analysis, tumor load stratified by PIV retained an independent prognostic value on PFS and OS, together with RT and performance status.


CONCLUSIONS
RT remains an important prognostic factor in patients with AEOC, but tumor dissemination can play a role in determining prognosis in these women.
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy, giuseppevizzielli@yahoo.it.
Giuseppe
G
Vizzielli
Barbara
B
Costantini
Lucia
L
Tortorella
Marco
M
Petrillo
Francesco
F
Fanfani
Vito
V
Chiantera
Alfredo
A
Ercoli
Raffaella
R
Iodice
Giovanni
G
Scambia
Anna
A
Fagotti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden