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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
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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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container_title	Gynecologic oncology
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creator	Aletti, Giovanni D Eisenhauer, Eric L Santillan, Antonio Axtell, Allison Aletti, Giacomo Holschneider, Christine Chi, Dennis S Bristow, Robert E Cliby, William A
description	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.
doi_str_mv	10.1016/j.ygyno.2010.09.010
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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.</description><identifier>ISSN: 0090-8258</identifier><identifier>EISSN: 1095-6859</identifier><identifier>DOI: 10.1016/j.ygyno.2010.09.010</identifier><identifier>PMID: 20933255</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>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</subject><ispartof>Gynecologic oncology, 2011-01, Vol.120 (1), p.23-28</ispartof><rights>Elsevier Inc.</rights><rights>2010 Elsevier Inc.</rights><rights>Copyright © 2010 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c529t-4e82638f3d6791539a520ca1d2438a5c007f20c3cc87458c251a258f6e29e1893</citedby><cites>FETCH-LOGICAL-c529t-4e82638f3d6791539a520ca1d2438a5c007f20c3cc87458c251a258f6e29e1893</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20933255$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aletti, Giovanni D</creatorcontrib><creatorcontrib>Eisenhauer, Eric L</creatorcontrib><creatorcontrib>Santillan, Antonio</creatorcontrib><creatorcontrib>Axtell, Allison</creatorcontrib><creatorcontrib>Aletti, Giacomo</creatorcontrib><creatorcontrib>Holschneider, Christine</creatorcontrib><creatorcontrib>Chi, Dennis S</creatorcontrib><creatorcontrib>Bristow, Robert E</creatorcontrib><creatorcontrib>Cliby, William A</creatorcontrib><title>Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment</title><title>Gynecologic oncology</title><addtitle>Gynecol Oncol</addtitle><description>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.</description><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Female</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Obstetrics and Gynecology</subject><subject>Ovarian cancer</subject><subject>Ovarian Neoplasms - drug therapy</subject><subject>Ovarian Neoplasms - pathology</subject><subject>Ovarian Neoplasms - surgery</subject><subject>Ovarian Neoplasms - therapy</subject><subject>Prognostic factors</subject><subject>Risk adjusted model</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Survival Rate</subject><subject>Tumor load</subject><issn>0090-8258</issn><issn>1095-6859</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNqFUcFu1DAUtBCIbku_AAn5xinLs73O2geQUEVLpUocgLPlOvaut0kcbKfS_j0v3cKBC6dnjWbG780Q8pbBmgFrPxzWx91xTGsOiIBe43hBVgy0bFol9UuyAtDQKC7VGTkv5QAAAhh_Tc44aCG4lCsSbjs_1hiiszWmkaZAJ3whRnc5zVOhttJ93O19qTTH8kBDTgOt2XZxEdie2mnKybo9rYmmR5ujHamzo_MZad7WAc3ekFfB9sVfPs8L8vP6y4-rr83dt5vbq893jZNc12bjFW-FCqJrt5pJoa3k4Czr-EYoKx3ANiAgnFPbjVSOS2bxvNB6rj1TWlyQ9ydfXOnXjDubIRbn-96OPs3FKIb2cgsMmeLEdDmVkn0wU46DzUfDwCz5moN5ytcs-RrQBgeq3j37z_eD7_5q_gSKhI8ngscrH6PPpjhM0_kuZu-q6VL8zwef_tG7Po7YTv_gj74c0pwx82KYKdyA-b5UvDTMsNxWQyt-A9YJopI</recordid><startdate>20110101</startdate><enddate>20110101</enddate><creator>Aletti, Giovanni D</creator><creator>Eisenhauer, Eric L</creator><creator>Santillan, Antonio</creator><creator>Axtell, Allison</creator><creator>Aletti, Giacomo</creator><creator>Holschneider, Christine</creator><creator>Chi, Dennis S</creator><creator>Bristow, Robert E</creator><creator>Cliby, William A</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110101</creationdate><title>Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment</title><author>Aletti, Giovanni D ; Eisenhauer, Eric L ; Santillan, Antonio ; Axtell, Allison ; Aletti, Giacomo ; Holschneider, Christine ; Chi, Dennis S ; Bristow, Robert E ; Cliby, William A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c529t-4e82638f3d6791539a520ca1d2438a5c007f20c3cc87458c251a258f6e29e1893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Female</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Obstetrics and Gynecology</topic><topic>Ovarian cancer</topic><topic>Ovarian Neoplasms - drug therapy</topic><topic>Ovarian Neoplasms - pathology</topic><topic>Ovarian Neoplasms - surgery</topic><topic>Ovarian Neoplasms - therapy</topic><topic>Prognostic factors</topic><topic>Risk adjusted model</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Survival Rate</topic><topic>Tumor load</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aletti, Giovanni D</creatorcontrib><creatorcontrib>Eisenhauer, Eric L</creatorcontrib><creatorcontrib>Santillan, Antonio</creatorcontrib><creatorcontrib>Axtell, Allison</creatorcontrib><creatorcontrib>Aletti, Giacomo</creatorcontrib><creatorcontrib>Holschneider, Christine</creatorcontrib><creatorcontrib>Chi, Dennis S</creatorcontrib><creatorcontrib>Bristow, Robert E</creatorcontrib><creatorcontrib>Cliby, William A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gynecologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aletti, Giovanni D</au><au>Eisenhauer, Eric L</au><au>Santillan, Antonio</au><au>Axtell, Allison</au><au>Aletti, Giacomo</au><au>Holschneider, Christine</au><au>Chi, Dennis S</au><au>Bristow, Robert E</au><au>Cliby, William A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment</atitle><jtitle>Gynecologic oncology</jtitle><addtitle>Gynecol Oncol</addtitle><date>2011-01-01</date><risdate>2011</risdate><volume>120</volume><issue>1</issue><spage>23</spage><epage>28</epage><pages>23-28</pages><issn>0090-8258</issn><eissn>1095-6859</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>20933255</pmid><doi>10.1016/j.ygyno.2010.09.010</doi><tpages>6</tpages></addata></record>
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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
title	Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment
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