Elsevier

Gynecologic Oncology

Volume 102, Issue 3, September 2006, Pages 447-452
Gynecologic Oncology

Influence of interval between primary surgery and chemotherapy on short-term survival of patients with advanced ovarian, tubal or peritoneal cancer

https://doi.org/10.1016/j.ygyno.2006.01.035Get rights and content

Abstract

Objective.

To investigate the impact on short-term survival of time between surgery and start of first chemotherapy cycle in patients with advanced ovarian cancer.

Methods.

This prospective, population-based study comprised 371 patients with epithelial ovarian, tubal or peritoneal cancer diagnosed in 2002–2003. All patients underwent primary surgery, followed at different intervals by chemotherapy. The data were derived from notifications to the Norwegian Cancer Registry and included medical, surgical and histopathological records. Kaplan–Meier plots were used to show differences in survival, and Cox regression analysis was used to show the effect of prognostic factors on survival, expressed as hazard ratios (HRs).

Results.

No difference in survival between patient groups was seen when time between surgery and start of chemotherapy was divided into quartiles. The group of patients with no residual disease and an interval between surgery and start of chemotherapy equal to or more than 6 weeks had non-significantly worse survival (unadjusted HR = 1.86; adjusted HR = 1.35) than those with an interval of less than 6 weeks. Patients with residual disease after surgery and chemotherapy at an interval of less than 6 weeks had worse short-term survival than patients without residual disease and the same interval before chemotherapy: unadjusted HR = 3.66 (95% CI, 2.09–6.40) and adjusted HR = 2.36 (95% CI, 1.22–4.57).

Conclusions.

The interval between surgery and start of chemotherapy had no major impact on short-term survival after ovarian cancer. Patients might be included in chemotherapy trials when interval between surgery and start of chemotherapy is more than 6 weeks. Any further investigation of a possible effect of interval between surgery and start of chemotherapy should be performed as a randomized trial.

Introduction

Ovarian cancer is one of the major causes of death from cancer among women in the western world [1]. The 5-year relative survival rate from ovarian cancer at any stage was 40% in Norway during the period 1997–2001 [2]. About two-thirds of ovarian cancers are in an advanced stage at the time of primary diagnosis [3]. Despite developments in surgery and chemotherapy, the 5-year survival rate has only slightly improved during the past few decades [4], [5].

Many prognostic factors have been described previously, including age, performance status, grade of differentiation, type of histology and presence of ascites. New prognostic factors that have been identified for advanced ovarian cancer include DNA ploidy, tumor suppressor genes, oncogenes and growth factors [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. The finding in experimental animal models of increased metastatic tumor growth after removal of a primary tumor might indicate that a short interval between surgery and start of chemotherapy is beneficial for survival [6], [16]. Clinical investigations have not, however, confirmed that supposition [17], [18]. Gadducci et al. proposed that a prospective study be conducted to improve the quality of the clinical investigations [17].

The aim of the present prospective, population-based study was to investigate whether the interval between surgery and date of first chemotherapy cycle influences the short-term survival of patients with advanced invasive ovarian, tubal or peritoneal cancer.

Section snippets

Materials and methods

The survey reported here was based on data described in a previous paper [3]. A total of 689 women in Norway with invasive epithelial tumors of the ovary, tube or peritoneum in FIGO1 stage IIC–IV were diagnosed between 1 January 2002 and 31 December 2003. We excluded 69 patients who were re-operated primarily, 68 patients treated with neoadjuvant chemotherapy before surgery, 103 patients not treated with chemotherapy, 67 patients who were

Results

Table 1 shows the distribution of prognostic factors according to SCI and residual disease status. Most patients had an SCI of <6 weeks, and most patients with an SCI <6 weeks and no residual disease were <65 years old (66%), while those with an SCI ≥6 weeks and residual disease were >65 years (66%, P < 0.05). SCI was shorter for patients with good performance status before treatment and no residual disease. More patients in stages IIC–IIIB than patients in stages IIIC and IV had undergone

Discussion

Differences in the interval between surgery and chemotherapy had no significant impact on short-term survival.

The introduction of postoperative chemotherapy in the treatment of advanced ovarian cancer was not based on the results of randomized trials; however, subsequent studies have indicated that the survival of patients given postoperative chemotherapy is better than that of persons not given chemotherapy [23], [24], [25], [26], [27], [28], [29], [30]. The results of randomized trials have

Acknowledgments

We would like to thank the health-care professionals in the hospitals and the medical encoders who participated in the data collection.

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