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Impact of delayed interval cytoreductive surgery on the survival of patients with advanced stage high-grade epithelial ovarian carcinoma
  1. Dimitrios Nasioudis1,
  2. Orlando Arevalo2,
  3. Stefan Gysler1,
  4. Emily M Ko1,
  5. Lori Cory1,
  6. Sarah H Kim1,
  7. Robert L Giuntoli II1 and
  8. Nawar A Latif1
  1. 1 Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2 University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Dimitrios Nasioudis, Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; dimitrios.nasioudis{at}pennmedicine.upenn.edu

Abstract

Objective Our objective was to use real-world data to investigate the impact of delayed interval cytoreductive surgery on the survival of patients with advanced stage high-grade ovarian carcinoma.

Methods We accessed the National Cancer Database and identified patients diagnosed between 2004–2015 with advanced stage high-grade ovarian carcinoma who received neoadjuvant chemotherapy and underwent interval cytoreductive surgery. Based on timing between surgery and chemotherapy administration patients were categorized into standard (9–13.0 weeks) and delayed (13.01–26 weeks) interval cytoreductive surgery groups. Overall survival was compared with the log-rank test and a Cox model was constructed to control for a priori selected confounders.

Results We identified a total of 5051 patients; 2389 (47.3%) and 2662 (52.7%) in the standard and delayed interval cytoreductive surgery groups respectively. There was no difference in complete gross resection rates (53.2% vs 54.5%, p=0.51). Patients in the delayed interval cytoreductive surgery group were less likely to undergo complex surgery (39.3% vs 45.6%, p<0.001) and had lower rates of unplanned re-admission (4.1% vs 2.6%, p=0.003). There was no difference in overall survival between the standard and delayed interval cytoreductive surgery groups, p=0.13 (median 34.3 vs 33.9 months) even after controlling for confounders (hazard ratio (HR) 1.04, 95% confidence intervals (CIs): 0.97, 1.12). There was no difference in overall survival between the two groups for patients with no gross residual (p=0.95; median overall survival 40.08 vs 39.8 months) or gross residual disease (p=0.16; median overall survival 32.89 and 32.16 months).

Conclusion For patients with advanced stage ovarian cancer delayed interval cytoreductive surgery may not be associated with worse overall survival.

  • Ovarian Cancer
  • Surgery

Data availability statement

Data may be obtained from a third party and are not publicly available. Data obtained from the American College of Surgeons.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data obtained from the American College of Surgeons.

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Footnotes

  • Contributors DN contributed to the conception, data acquisition, data management, statistical analysis, critical analysis, drafting/final editing, guarantor. OH, AH, SK, EK, LC, RG contributed to critical analysis, drafting/final editing. NL contributed to supervision, critical analysis, drafting/final editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.