title: Does aggressive surgery improve outcomes? Interaction between preoperative disease burden and complex surgery in patients with advanced-stage ovarian cancer: an analysis of GOG 182.
abstract: OBJECTIVE
  To examine the effects of disease burden, complex surgery, and residual disease (RD) status on progression-free (PFS) and overall survival (OS) in patients with advanced epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and complete surgical resection (R0) or < 1 cm of RD (MR) after surgical cytoreduction.
  
  
  METHODS
  Demographic, pathologic, surgical, and outcome data were collected from 2,655 patients with EOC or PPC enrolled onto the Gynecologic Oncology Group 182 study. The effects of disease distribution (disease score [DS]) and complexity of surgery (complexity score [CS]) on PFS and OS were assessed using the Kaplan-Meier method and multivariable regression analysis.
  
  
  RESULTS
  Consistent with existing literature, patients with MR had worse prognosis than R0 patients (PFS, 15 v 29 months; P < .01; OS, 41 v 77 months; P < .01). Patients with the highest preoperative disease burden (DS high) had shorter PFS (15 v 23 or 34 months; P < .01) and OS (40 v 71 or 86 months; P < .01) compared with those with DS moderate or low, respectively. This relationship was maintained in the subset of R0 patients with PFS (18.3 v 33.2 months; DS moderate or low: P < .001) and OS (50.1 v 82.8 months; DS moderate or low: P < .001). After controlling for DS, RD, an interaction term for DS/CS, performance status, age, and cell type, CS was not an independent predictor of either PFS or OS.
  
  
  CONCLUSIONS
  In this large multi-institutional sample, initial disease burden remained a significant prognostic indicator despite R0. Complex surgery does not seem to affect survival when accounting for other confounding influences, particularly RD.
authors: Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA.
authors: Neil S
authors: NS
authors: Horowitz
authors: Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA.
authors: Austin
authors: A
authors: Miller
authors: Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA.
authors: Bunja
authors: B
authors: Rungruang
authors: Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA.
authors: Scott D
authors: SD
authors: Richard
authors: Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA.
authors: Noah
authors: N
authors: Rodriguez
authors: Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA.
authors: Michael A
authors: MA
authors: Bookman
authors: Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA.
authors: Chad A
authors: CA
authors: Hamilton
authors: Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA.
authors: Thomas C
authors: TC
authors: Krivak
authors: Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA. george.maxwell@inova.org.
authors: G Larry
authors: GL
authors: Maxwell
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015999:Multivariate Analysis; D018365:Neoplasm, Residual; D010051:Ovarian Neoplasms / Q000601:surgery* / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000601:surgery* / Q000628:therapy; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome