Bunja J Rungruang1, Austin Miller2, Thomas C Krivak3, Neil S Horowitz4, Noah Rodriguez5, Chad A Hamilton6, Floor J Backes7, Linda F Carson8, Michael Friedlander9, David G Mutch10, Michael J Goodheart11, Krishnansu S Tewari12, Robert M Wenham13, Michael A Bookman14, G Larry Maxwell15, Scott D Richard16. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Georgia of Augusta University, Augusta, Georgia. 2. Gynecologic Oncology Group, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, New York. 3. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Western Pennsylvania Allegheny Hospital, Pittsburgh, Pennsylvania. 4. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham & Women's Hospital, Boston, Massachusetts. 5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente Irvine Medical Center, Irvine, California. 6. Gynecologic Oncology Service, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland. 7. Division of Gynecologic Oncology, Department Obstetrics and Gynecology, Ohio State University Medical Center, Columbus, Ohio. 8. Department of OB/GYN and Women's Health, University of Minnesota School of Medicine, Minneapolis, Minnesota. 9. Department of Cancer Medicine, ANZGOG, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. 10. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri. 11. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa. 12. Department of Obstetrics and Gynecology, University of California Medical Center-Irvine, Orange, California. 13. Department of Gynecology Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida. 14. Medical Oncology, Arizona Oncology, Tuscon, Arizona. 15. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Inova Fairfax Hospital Women's Center, Falls Church, Virginia. 16. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: The purpose of this study was to determine the effect of retroperitoneal (RP) exploration on progression-free survival (PFS) and overall survival (OS) in epithelial ovarian cancer (EOC) patients with stage IIIC disease who underwent optimal debulking surgery. METHODS: Data were collected from records of the Gynecologic Oncology Group 182 (GOG-182) study of stage IIIC EOC patients cytoreduced to no gross residual disease (R0) or minimal gross residual (<1 cm) disease (MGRD) at primary surgery. Patients with stage IIIC disease by intraperitoneal (IP) tumor were included and divided into 3 groups: 1) > 2 cm IP tumor without lymph node involvement (IP/RP-), 2) > 2 cm IP tumor with lymph node involvement (IP/RP+), and 3) > 2 cm IP tumor with no RP exploration (IP/RP?). The effects of disease distribution and RP exploration on PFS and OS were assessed using Kaplan-Meier and proportional hazards methods. RESULTS: There were 1871 stage IIIC patients in GOG-182 who underwent optimal primary debulking surgery. Of these, 689 (36.8%) underwent RP exploration with removal of lymph nodes from at least 1 para-aortic site, and 1182 (63.2%) did not. There were 269 patients in the IP/RP- group, 420 patients in the IP/RP + group, and 1182 patients in the IP/RP? group. Improved PFS (18.5 vs 16.0 months; P < .0001) and OS (53.3 vs 42.8 months; P < .0001) were associated with RP exploration versus no exploration. Patients with MGRD had improved PFS (16.8 vs 15.1 months, P = 0.0108) and OS (44.9 vs 40.5 months, P = 0.0076) versus no exploration. CONCLUSIONS: RP exploration at the time of primary surgery in patients with optimally debulked stage IIIC EOC is associated with a survival benefit. Cancer 2017;123:985-93.
BACKGROUND: The purpose of this study was to determine the effect of retroperitoneal (RP) exploration on progression-free survival (PFS) and overall survival (OS) in epithelial ovarian cancer (EOC) patients with stage IIIC disease who underwent optimal debulking surgery. METHODS: Data were collected from records of the Gynecologic Oncology Group 182 (GOG-182) study of stage IIIC EOC patients cytoreduced to no gross residual disease (R0) or minimal gross residual (<1 cm) disease (MGRD) at primary surgery. Patients with stage IIIC disease by intraperitoneal (IP) tumor were included and divided into 3 groups: 1) > 2 cm IP tumor without lymph node involvement (IP/RP-), 2) > 2 cm IP tumor with lymph node involvement (IP/RP+), and 3) > 2 cm IP tumor with no RP exploration (IP/RP?). The effects of disease distribution and RP exploration on PFS and OS were assessed using Kaplan-Meier and proportional hazards methods. RESULTS: There were 1871 stage IIIC patients in GOG-182 who underwent optimal primary debulking surgery. Of these, 689 (36.8%) underwent RP exploration with removal of lymph nodes from at least 1 para-aortic site, and 1182 (63.2%) did not. There were 269 patients in the IP/RP- group, 420 patients in the IP/RP + group, and 1182 patients in the IP/RP? group. Improved PFS (18.5 vs 16.0 months; P < .0001) and OS (53.3 vs 42.8 months; P < .0001) were associated with RP exploration versus no exploration. Patients with MGRD had improved PFS (16.8 vs 15.1 months, P = 0.0108) and OS (44.9 vs 40.5 months, P = 0.0076) versus no exploration. CONCLUSIONS: RP exploration at the time of primary surgery in patients with optimally debulked stage IIIC EOC is associated with a survival benefit. Cancer 2017;123:985-93.
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