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Does Significant Medical Comorbidity Negate the Benefit of Up-front Cytoreduction in Advanced Ovarian Cancer?
  1. James Stuart Ferriss, MD,
  2. Kari Ring, MD,
  3. Erin R. King, MD,
  4. Madeleine Courtney-Brooks, MD,
  5. Linda R. Duska, MD and
  6. Peyton T. Taylor, MD
  1. Thornton Gynecologic Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA.
  1. Address correspondence and reprint requests to James Stuart Ferriss, MD, Temple University School of Medicine, 3401 N Broad St, 7 OPB, Philadelphia, PA 19140. E-mail: jferriss@temple.edu.

Abstract

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.

  • Epithelial ovarian cancer
  • Neoadjuvant chemotherapy
  • Medical comorbidities

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Footnotes

  • The authors have no conflicts of interest to declare.

  • This article was presented as a poster presentation at the Society of Gynecologic Oncology 41st Annual Meeting, San Francisco, CA, March 10-17, 2010. This was also presented as an oral presentation at the Mid-Atlantic Gynecologic Oncology Society meeting in Richmond, VA, October 28-30, 2010.

  • Diabetes is an independent risk factor for death in ovarian cancer patients. Surgical success alone is insufficient to improve survival.

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