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