BACKGROUND: The objective of the study was to determine if initial surgery (IS) or initial chemotherapy (IC) affects rates of optimal surgery and survival in a population with significant medical comorbidities. METHODS: Data of all patients with stage III-IV ovarian, peritoneal, and fallopian tube cancers diagnosed from 1995 to 2008 were reviewed. Clinical and pathologic data were abstracted. RESULTS: There were 551 cases for review: 255 (46.3%) received IS, and 296 (53.7%) received IC. Patients who received IC had higher stage (P < 0.001), higher-grade cancers (P < 0.001), higher mean CA-125 (P = 0.015), higher rates of diabetes (P = 0.006), hypertension (P = 0.008), and presurgical embolism (P < 0.022) and were older (P = 0.043). There was no difference with respect to body mass index, albumin, extent of surgery, or intensive care use. Rates of optimal cytoreduction were higher with IC compared with IS (72.7% vs 56.1%, P < 0.001). IS was associated with more blood loss (P = 0.005) and higher rates of postsurgical venous thrombosis (P < 0.001). Optimal cytoreduction predicted survival in both groups. Among optimal patients, IS improved median survival: progression-free survival of 14 months (IS) versus 12 months (IC), P = 0.004; overall survival of 58 months (IS) versus 34 months (IC), P = 0.002. Factors influencing this difference were receipt of IC and history of diabetes; both predictors of mortality: hazard ratios, 1.9 (95% confidence interval, 1.3-2.8; P < 0.001) and 1.8 (95% confidence interval, 1.02-3.1; P = 0.042), respectively. CONCLUSIONS: The achievement of optimal cytoreduction continues to be a significant predictor of survival, regardless of treatment approach. Patients selected for IS and in whom optimal cytoreduction was achieved had improvements in both progression-free survival and overall survival. However, the differences could not be explained by surgical effort alone as diabetes was independently associated with mortality.
BACKGROUND: The objective of the study was to determine if initial surgery (IS) or initial chemotherapy (IC) affects rates of optimal surgery and survival in a population with significant medical comorbidities. METHODS: Data of all patients with stage III-IV ovarian, peritoneal, and fallopian tube cancers diagnosed from 1995 to 2008 were reviewed. Clinical and pathologic data were abstracted. RESULTS: There were 551 cases for review: 255 (46.3%) received IS, and 296 (53.7%) received IC. Patients who received IC had higher stage (P < 0.001), higher-grade cancers (P < 0.001), higher mean CA-125 (P = 0.015), higher rates of diabetes (P = 0.006), hypertension (P = 0.008), and presurgical embolism (P < 0.022) and were older (P = 0.043). There was no difference with respect to body mass index, albumin, extent of surgery, or intensive care use. Rates of optimal cytoreduction were higher with IC compared with IS (72.7% vs 56.1%, P < 0.001). IS was associated with more blood loss (P = 0.005) and higher rates of postsurgical venous thrombosis (P < 0.001). Optimal cytoreduction predicted survival in both groups. Among optimal patients, IS improved median survival: progression-free survival of 14 months (IS) versus 12 months (IC), P = 0.004; overall survival of 58 months (IS) versus 34 months (IC), P = 0.002. Factors influencing this difference were receipt of IC and history of diabetes; both predictors of mortality: hazard ratios, 1.9 (95% confidence interval, 1.3-2.8; P < 0.001) and 1.8 (95% confidence interval, 1.02-3.1; P = 0.042), respectively. CONCLUSIONS: The achievement of optimal cytoreduction continues to be a significant predictor of survival, regardless of treatment approach. Patients selected for IS and in whom optimal cytoreduction was achieved had improvements in both progression-free survival and overall survival. However, the differences could not be explained by surgical effort alone as diabetes was independently associated with mortality.
Authors: Albina N Minlikeeva; Jo L Freudenheim; Rikki A Cannioto; J Brian Szender; Kevin H Eng; Francesmary Modugno; Roberta B Ness; Michael J LaMonte; Grace Friel; Brahm H Segal; Kunle Odunsi; Paul Mayor; Emese Zsiros; Barbara Schmalfeldt; Rüdiger Klapdor; Thilo Dӧrk; Peter Hillemanns; Linda E Kelemen; Martin Kӧbel; Helen Steed; Anna de Fazio; Susan J Jordan; Christina M Nagle; Harvey A Risch; Mary Anne Rossing; Jennifer A Doherty; Marc T Goodman; Robert Edwards; Keitaro Matsuo; Mika Mizuno; Beth Y Karlan; Susanne K Kjær; Estrid Høgdall; Allan Jensen; Joellen M Schildkraut; Kathryn L Terry; Daniel W Cramer; Elisa V Bandera; Lisa E Paddock; Lambertus A Kiemeney; Leon F Massuger; Jolanta Kupryjanczyk; Andrew Berchuck; Jenny Chang-Claude; Brenda Diergaarde; Penelope M Webb; Kirsten B Moysich Journal: Cancer Causes Control Date: 2017-03-14 Impact factor: 2.506
Authors: Basel Refky; Sherif Kotb; Tamer Fady; Ahmad Marwan; Doaa Abd El-Khalek; Waleed Elnahas; Mohamed T Hafez; Eduard Malik; Amr A Soliman Journal: BMC Cancer Date: 2015-10-21 Impact factor: 4.430
Authors: Yael N Kusne; Heidi E Kosiorek; Matthew R Buras; Kyle E Coppola; Patricia M Verona; Curtiss B Cook; Nina J Karlin Journal: Future Sci OA Date: 2020-12-18