Elsevier

Gynecologic Oncology

Volume 86, Issue 3, September 2002, Pages 354-357
Gynecologic Oncology

Regular Article
Does the Interval from Primary Surgery to Chemotherapy Influence Progression-Free Survival in Ovarian Cancer?

https://doi.org/10.1006/gyno.2002.6750Get rights and content

Abstract

Objectives. The objective of this study was to determine whether the length of the interval from primary surgery to commencement of chemotherapy has any direct effect on progression-free survival in ovarian cancer.

Methods. The progression-free survival of 472 patients enrolled in four trials who had all received platinum-containing chemotherapy (either in combination with a taxane or cyclophospamide) was subjected to univariate analysis. Dividing subjects into those above and below the median interval from surgery to chemotherapy formed two groups for analysis. The analysis was stratified by study and arm/cohort within study to remove any possible influence of the different studies and study doses. Multivariate analysis was then performed including stage, bulk of residual disease, and performance status as well as interval to starting chemotherapy.

Results. The median interval from surgery to chemotherapy was 22 days (range 7–100). Univariate analysis of the above median and below median groups showed worse progression-free survival for those with earlier treatment (hazard ratio 0.84, P = 0.14, 95% CI 0.67–1.06); however, those treated earlier tended to have bulkier residual disease (>2 cm; P = 0.006). When multivariate analysis was performed incorporating residual disease status, FIGO stage, and performance status, the hazard rate ratio for interval to surgery was 0.99 (P = 0.91, 95% CI 0.79–1.24).

Conclusions. This study suggests that the interval from surgery to commencement of chemotherapy is not an independent prognostic factor for progression-free survival.

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    These differences illustrate the heterogeneity of studied populations and therefore may explain the inconsistent outcomes. In addition, TTC intervals were based on either IQR [13–15], median TTC [6, 7, 18, 20], or various weeks [16, 17, 19, 21–23], which also contributes to the conflicting results. In our study, we chose for IQR and compared the outliers (lowest and highest IQR groups) with the intermediate group (mean IQR) as we were interested if either early or late start influenced clinical outcomes.

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To whom correspondence should be addressed at present address: University Hospital of North Tees, Hardwick, Stockton on Tees, TS19 8PE, United Kingdom. Fax: +44 7092 173892. E-mail: [email protected].

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