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. 2010 Mar;116(3):351-7.
doi: 10.1016/j.ygyno.2009.11.022.

The effect of primary cytoreduction on outcomes of patients with FIGO stage IIIC ovarian cancer stratified by the initial tumor burden in the upper abdomen cephalad to the greater omentum

Oliver Zivanovic  1 , Camelia S Sima, Alexia Iasonos, William J Hoskins, Pavani R Pingle, Mario M M Leitao Jr, Yukio Sonoda, Nadeem R Abu-Rustum, Richard R Barakat, Dennis S Chi
Affiliations

The effect of primary cytoreduction on outcomes of patients with FIGO stage IIIC ovarian cancer stratified by the initial tumor burden in the upper abdomen cephalad to the greater omentum

Oliver Zivanovic et al. Gynecol Oncol. 2010 Mar.

Abstract

Objective: Our objective was to analyze the effect of surgical outcome on progression-free survival (PFS) and overall survival (OS) of patients with advanced ovarian carcinoma stratified by the initial presence and volume of upper abdominal disease cephalad to the greater omentum (UAD) found at the time of exploration.

Methods: We evaluated all patients with FIGO stage IIIC ovarian carcinoma who underwent primary cytoreduction followed by platinum-based chemotherapy at our institution between January 1989 and December 2006. The effect of surgical outcome was investigated using a time-to-event analysis. A Cox proportional hazards model was fit using clinical, surgical, and postoperative variables.

Results: We identified 526 evaluable patients. Optimal versus suboptimal cytoreduction was significantly associated with improved median PFS and OS in patients with no, minimal (<or=1 cm), and bulky (>1 cm) UAD. On multivariate analysis, patients with bulky UAD who underwent optimal cytoreduction had a 28% decreased risk of relapse (hazard ratio, 0.72; 95% confidence interval: 0.53-0.99; P=0.04) and a 33% decreased risk of death (hazard ratio, 0.67; 95% confidence interval: 0.47-0.96; P=0.03) compared to patients who underwent suboptimal cytoreduction.

Conclusion: The presence of large-volume disease found during surgical exploration does not preclude the benefit of optimal cytoreduction. The findings support the management strategy of maximizing surgical efforts with increasing tumor burden in patients with stage IIIC ovarian cancer. Prospective studies are needed to more precisely quantify tumor burden and accurately determine the specific impact of cytoreduction on outcome.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

  1. Oliver Zivanovic, MD: no conflicts of interest to declare

  2. Camelia Sima: no conflicts of interest to declare

  3. Alexia Iasonos, PhD: no conflicts of interest to declare

  4. William J. Hoskins, MD: no conflicts of interest to declare

  5. Pavani R. Pingle: no conflicts of interest to declare

  6. Mario MM Leitao Jr, MD: Genzyme – consultant/speaker; Intuitive Surgical – surgical proctor

  7. Yukio Sonoda, MD: Plasma Surgical – research support; Covidien – consultant; Genzyme – speaker

  8. Nadeem R. Abu-Rustum, MD: no conflicts of interest to declare

  9. Richard R. Barakat, MD: no conflicts of interest to declare

  10. Dennis S. Chi, MD: Genzyme – speaker

Figures

Figure 1
Figure 1
Three different groups of patients presenting with FIGO stage IIIC ovarian carcinoma (uterus, fallopian tubes/ovaries, and omentum removed) and their peritoneal disease distribution at the beginning of the operative procedure. (A), upper abdomen cephalad to the greater omentum; (B), mid-abdomen; (C), pelvis; UAD, upper abdominal disease cephalad to the greater omentum UAD is defined as metastatic implants involving the diaphragm, liver, porta hepatis, spleen, pancreas, stomach, celiac axis, and lesser sac. Group 1 includes patients without visible or palpable UAD (Region A) at the time of exploration. Group 2 consists of patients with minimal UAD (1 cm or less), and Group 3 consists of patients with bulky UAD (larger than 1 cm).
Figure 2A
Figure 2A
Estimated progression-free survival of patients with no UAD stratified by residual disease (optimal versus suboptimal). Patients who were optimally cytoreduced were further stratified into two groups based on the amount of residual disease remaining after cytoreductive surgery (no gross residual disease versus minimal residual disease of 1 cm or less in maximum diameter).
Figure 2B
Figure 2B
Estimated progression-free survival of patients with minimal UAD stratified by residual disease (optimal versus suboptimal). Patients who were optimally cytoreduced were further stratified into two groups based on the amount of residual disease remaining after cytoreductive surgery (no gross residual disease versus minimal residual disease of 1 cm or less in maximum diameter).
Figure 2C
Figure 2C
Estimated progression-free survival of patients with bulky UAD stratified by residual disease (optimal versus suboptimal). Patients who were optimally cytoreduced were further stratified into two groups based on the amount of residual disease remaining after cytoreductive surgery (no gross residual disease versus minimal residual disease of 1 cm or less in maximum diameter).
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References

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