title: Long-term survival advantage and prognostic factors associated with intraperitoneal chemotherapy treatment in advanced ovarian cancer: a gynecologic oncology group study.
abstract: OBJECTIVE
  To determine long-term survival and associated prognostic factors after intraperitoneal (IP) chemotherapy in patients with advanced ovarian cancer.
  
  
  METHODS
  Data from Gynecologic Oncology Group protocols 114 and 172 were retrospectively analyzed. Cox proportional hazards regression models were used for statistical analyses.
  
  
  RESULTS
  In 876 patients, median follow-up was 10.7 years. Median survival with IP therapy was 61.8 months (95% CI, 55.5 to 69.5), compared with 51.4 months (95% CI, 46.0 to 58.2) for intravenous therapy. IP therapy was associated with a 23% decreased risk of death (adjusted hazard ratio [AHR], 0.77; 95% CI, 0.65 to 0.90; P = .002). IP therapy improved survival of those with gross residual (≤ 1 cm) disease (AHR, 0.75; 95% CI, 0.62 to 0.92; P = .006). Risk of death decreased by 12% for each cycle of IP chemotherapy completed (AHR, 0.88; 95% CI, 0.83 to 0.94; P < .001). Factors associated with poorer survival included: clear/mucinous versus serous histology (AHR, 2.79; 95% CI, 1.83 to 4.24; P < .001), gross residual versus no visible disease (AHR, 1.89; 95% CI, 1.48 to 2.43; P < .001), and fewer versus more cycles of IP chemotherapy (AHR, 0.88; 95% CI, 0.83 to 0.94; P < .001). Younger patients were more likely to complete the IP regimen, with a 5% decrease in probability of completion with each year of age (odds ratio, 0.95; 95% CI, 0.93 to 0.96; P < .001).
  
  
  CONCLUSIONS
  The advantage of IP over intravenous chemotherapy extends beyond 10 years. IP therapy enhanced survival of those with gross residual disease. Survival improved with increasing number of IP cycles.
authors: Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ.
authors: Devansu
authors: D
authors: Tewari
authors: Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ.
authors: James J
authors: JJ
authors: Java
authors: Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ.
authors: Ritu
authors: R
authors: Salani
authors: Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ.
authors: Deborah K
authors: DK
authors: Armstrong
authors: Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ.
authors: Maurie
authors: M
authors: Markman
authors: Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ.
authors: Thomas
authors: T
authors: Herzog
authors: Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ.
authors: Bradley J
authors: BJ
authors: Monk
authors: Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ. chanjohn@sutterhealth.org.
authors: John K
authors: JK
authors: Chan
mesh_terms: D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D000077216:Carcinoma, Ovarian Epithelial; D016009:Chi-Square Distribution; D002945:Cisplatin / Q000008:administration & dosage; D017326:Clinical Trials, Phase III as Topic; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007263:Infusions, Parenteral; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015999:Multivariate Analysis; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017239:Paclitaxel / Q000008:administration & dosage; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin