Thomas Boerner1, Edward Tanner2, Olga Filippova1, Qin C Zhou3, Alexia Iasonos3, William P Tew4, Roisin E O'Cearbhaill4, Rachel N Grisham4, Ginger J Gardner5, Yukio Sonoda5, Nadeem R Abu-Rustum5, Oliver Zivanovic5, Kara Long Roche5, Anoushka M Afonso6, Mary Fischer6, Dennis S Chi7. 1. Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 2. Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 4. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA. 5. Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA. 6. Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Department of Anesthesia, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 7. Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA. Electronic address: chid@mskcc.org.
Abstract
OBJECTIVE: To describe oncologic outcomes after using acute normovolemic hemodilution (ANH) to reduce requirement for allogenic red blood cell transfusions (ABT) in patients undergoing primary debulking surgery (PDS) for advanced ovarian cancer. METHODS: We performed a post-hoc analysis of a recent prospective trial investigating the safety and feasibility of ANH during PDS for advanced ovarian cancer. We report long-term survival outcomes. We compared demographics, clinicopathological characteristics, survival outcomes in this cohort of Stage IIIB-IVB high-grade serous ovarian cancer patients undergoing ANH (ANH group), with a retrospective cohort of all other patients (standard group) undergoing PDS during the same time period (01/2012-04/2017). Standard statistical tests were used. RESULTS: There were no demographic or clinicopathological differences between ANH (n = 33) and standard groups (n = 360), except for higher median age at diagnosis (57 vs. 62 years, respectively; p = 0.044) and shorter operative time (357 vs. 446 min, respectively; p < 0.001) in the standard group. Cytoreductive outcomes (ANH vs. standard): 0 mm, 69.7 vs. 63.9%; gross residual disease (RD) ≤1 cm, 21.2 vs. 26.9%; >1 cm, 9.1 vs. 9.2% (p = 0.78). RD after PDS was the only independent factor associated with worse progression-free survival (PFS) on multivariable analysis (p < 0.001). Patients with BRCA mutations trended towards improved PFS (p = 0.057). Significant factors for overall survival (OS) on multivariable analysis: preoperative CA125 (p = 0.004), ascites (p = 0.018), RD after PDS (p = 0.04), BRCA mutation status (p < 0.001). After adjustment for potential confounders, ANH was not independently associated with PFS or OS [PFS: HR 0.928 (0.618-1.395); p = 0.721; OS: HR 0.588 (95%CI: 0.317-1.092); p = 0.093]. CONCLUSIONS: ANH is an innovative approach in intraoperative management. It was previously proven to decrease need for ABT while maintaining the ability to achieve complete gross resection and associated benefits.
OBJECTIVE: To describe oncologic outcomes after using acute normovolemic hemodilution (ANH) to reduce requirement for allogenic red blood cell transfusions (ABT) in patients undergoing primary debulking surgery (PDS) for advanced ovarian cancer. METHODS: We performed a post-hoc analysis of a recent prospective trial investigating the safety and feasibility of ANH during PDS for advanced ovarian cancer. We report long-term survival outcomes. We compared demographics, clinicopathological characteristics, survival outcomes in this cohort of Stage IIIB-IVB high-grade serous ovarian cancer patients undergoing ANH (ANH group), with a retrospective cohort of all other patients (standard group) undergoing PDS during the same time period (01/2012-04/2017). Standard statistical tests were used. RESULTS: There were no demographic or clinicopathological differences between ANH (n = 33) and standard groups (n = 360), except for higher median age at diagnosis (57 vs. 62 years, respectively; p = 0.044) and shorter operative time (357 vs. 446 min, respectively; p < 0.001) in the standard group. Cytoreductive outcomes (ANH vs. standard): 0 mm, 69.7 vs. 63.9%; gross residual disease (RD) ≤1 cm, 21.2 vs. 26.9%; >1 cm, 9.1 vs. 9.2% (p = 0.78). RD after PDS was the only independent factor associated with worse progression-free survival (PFS) on multivariable analysis (p < 0.001). Patients with BRCA mutations trended towards improved PFS (p = 0.057). Significant factors for overall survival (OS) on multivariable analysis: preoperative CA125 (p = 0.004), ascites (p = 0.018), RD after PDS (p = 0.04), BRCA mutation status (p < 0.001). After adjustment for potential confounders, ANH was not independently associated with PFS or OS [PFS: HR 0.928 (0.618-1.395); p = 0.721; OS: HR 0.588 (95%CI: 0.317-1.092); p = 0.093]. CONCLUSIONS: ANH is an innovative approach in intraoperative management. It was previously proven to decrease need for ABT while maintaining the ability to achieve complete gross resection and associated benefits.
Authors: Maria B Schiavone; Lea Moukarzel; Kam Leong; Qin C Zhou; Anoushka M Afonso; Alexia Iasonos; Kara Long Roche; Mario M Leitao; Dennis S Chi; Nadeem R Abu-Rustum; Oliver Zivanovic Journal: Gynecol Oncol Date: 2017-07-19 Impact factor: 5.482
Authors: Meghan Delaney; Silvano Wendel; Rachel S Bercovitz; Joan Cid; Claudia Cohn; Nancy M Dunbar; Torunn O Apelseth; Mark Popovsky; Simon J Stanworth; Alan Tinmouth; Leo Van De Watering; Jonathan H Waters; Mark Yazer; Alyssa Ziman Journal: Lancet Date: 2016-04-12 Impact factor: 79.321
Authors: Koo-Whang Chung; Sridhar V Basavaraju; Yi Mu; Katharina L van Santen; Kathryn A Haass; Richard Henry; James Berger; Matthew J Kuehnert Journal: Transfusion Date: 2016-05-12 Impact factor: 3.157
Authors: Dennis S Chi; Eric L Eisenhauer; Oliver Zivanovic; Yukio Sonoda; Nadeem R Abu-Rustum; Douglas A Levine; Matthew W Guile; Robert E Bristow; Carol Aghajanian; Richard R Barakat Journal: Gynecol Oncol Date: 2009-04-23 Impact factor: 5.482