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The Use of “Optimal Cytoreduction” Nomenclature in Ovarian Cancer Literature: Can We Move Toward a More Optimal Classification System?
  1. Ana Milena Angarita, MD,
  2. Rebecca Stone, MD,
  3. Sarah M. Temkin, MD,
  4. Kimberly Levinson, MD, MPH,
  5. Amanda N. Fader, MD and
  6. Edward J. Tanner, MD
  1. Department of Gynecology and Obstetrics, The Kelly Gynecologic Oncology Service, Johns Hopkins Hospital, Baltimore, MD.
  1. Address correspondence and reprint requests to Edward J. Tanner, MD, 600 N Wolfe St, Phipps 281, Baltimore, MD 21287. E-mail: etanner4{at}


Objectives The objective of this study is to explore how cytoreductive surgical outcomes such as residual disease (RD) and use of the term “optimal cytoreduction” (OCR) have changed over time in the ovarian cancer literature.

Methods We identified all English-language publications referring to ovarian cancer cytoreduction for a 12-year period. Publications were evaluated for how the diameter of RD was categorized and whether OCR was defined. In addition, the use of RD and OCR terminology trends over time and associations between terminology and the region of corresponding author, study type, and journal impact factor were explored.

Results Of the 772 publications meeting inclusion criteria, the RD stratification points used to demarcate patient groups were as follows: 0 mm (45%), 5 mm (3.6%), 10 mm (65%), and 20 mm (24%). The use of 0-mm RD (odds ratio [OR], 1.1; 95% confidence interval, 1.05–1.15) and 10-mm RD (OR, 1.1; 95% confidence interval, 1.09–1.20) to delineate patient outcomes increased over time. The use of OCR terminology did not change over time but was more commonly used in clinical studies as well as those from North America. Many studies (70%) defined OCR as less than or equal to 10-mm RD, whereas 30% defined OCR differently or not at all.

Conclusions Optimal cytoreduction terminology remains ambiguous and inconsistently used in the ovarian cancer surgical literature. On the basis of this literature review, we propose a novel classification system to categorize RD without reference to OCR while accurately and succinctly identifying meaningful clinical subgroups and minimizing bias.

  • Ovarian cancer
  • Surgical cytoreduction
  • Residual disease

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  • The authors declare no conflicts of interest.