Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment

Abstract Objective Define subgroups of patients at highest risk for major morbidity and mortality after a traditional approach of maximal surgical efforts followed by chemotherapy for advanced ovarian cancer (AOC). Methods Preoperative health, intra-operative findings and outcomes were assessed in c...

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Published in:Gynecologic oncology 2011-01, Vol.120 (1), p.23-28
Main Authors: Aletti, Giovanni D, Eisenhauer, Eric L, Santillan, Antonio, Axtell, Allison, Aletti, Giacomo, Holschneider, Christine, Chi, Dennis S, Bristow, Robert E, Cliby, William A
Format: Article
Language:English
Subjects:
Adult
Age
Aged
Aged, 80 and over
Female
Hematology, Oncology and Palliative Medicine
Humans
Middle Aged
Neoplasm Staging
Obstetrics and Gynecology
Ovarian cancer
Ovarian Neoplasms - drug therapy
Ovarian Neoplasms - pathology
Ovarian Neoplasms - surgery
Ovarian Neoplasms - therapy
Prognostic factors
Risk adjusted model
Risk Factors
Surgery
Survival Rate
Tumor load
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Summary:Abstract Objective Define subgroups of patients at highest risk for major morbidity and mortality after a traditional approach of maximal surgical efforts followed by chemotherapy for advanced ovarian cancer (AOC). Methods Preoperative health, intra-operative findings and outcomes were assessed in consecutive patients with primary AOC from 4 centers. Initial tumor dissemination was stratified into 3 groups based on volume of disease. Surgery was categorized using a previously described surgical complexity score (SCS). Statistical analysis was directed toward validating a multivariable risk-adjusted model. Results 576 patients with stage IIIC (N = 447, 77.6%) or IV AOC (N = 129, 22.4%) were analyzed. Age (HR (per year): 1.02; 95%CI: 1.01–1.03), high tumor dissemination (HTD) (HR: 1.73; 95%CI: 1.19–2.56), residual disease (RD) > 1 cm (HR: 2.46; 95%CI: 1.74–3.53), and stage IV (HR: 1.93; 95% CI: 1.51–2.45), independently correlated with OS. We identified a small subgroup of patients who comprised a high-risk group (N = 38, 6.6%) characterized by all of the following characteristics: high initial tumor dissemination (HTD) or stage IV plus poor performance or nutritional status plus age ≥ 75. In this group, high SCS to achieve low RD was associated with morbidity of 63.6% and limited survival benefit. Conclusions Optimal management of AOC requires accurate, risk-adjusted predictors of outcomes allowing a tailored approach starting with primary therapy. Complex surgical procedures to render low RD improve survival, and in the majority of cases, the benefits of such surgery appear to outweigh the morbidity. However careful analysis identifies a subgroup of patients in whom an alternative approach may be the better strategy.
ISSN:0090-8258
1095-6859
DOI:10.1016/j.ygyno.2010.09.010