Ascites volume at the time of primary debulking and overall survival of patients with advanced-stage epithelial ovarian cancer

Abstract

Objectives: Investigate the impact of malignant ascites volume on the overall survival of patients with advanced stage epithelial ovarian carcinoma who undergo primary debulking surgery and achieve complete gross resection. Methods: Patients without a history of another tumor diagnosed with stage III-IV epithelial ovarian carcinoma and bulky intra-abdominal disease between 2004-2015, who underwent primary debulking surgery followed by adjuvant chemotherapy and achieved complete gross resection were drawn from the National Cancer Database. Based on available information, the presence and volume of malignant ascites was assessed and categorized as absent, low (<980 ml) and high (≥980 ml) volume. Median overall survival was determined following generation of Kaplan-Meier curves and compared with the log-rank test. A multivariate Cox model was constructed to control for confounders. Results: A total of 1040 patients who met the inclusion criteria were identified; 50.4% had no ascites, 34.2% had low and 15.4% had high volume malignant ascites at the time of primary debulking surgery. Median patient age was 61 years, while the majority were White (87.7%), without co-morbidities (81.1%) and had serous tumors (91.8%). Groups were comparable in terms of patient race, presence of comorbidities, tumor histology and grade. Median OS of patients without malignant ascites was 59.79 months, compared to 50.33 months for those who had low volume and 41.95 months for those who had high volume malignant ascites. After controlling for patient age, race, insurance status, presence of comorbidities and tumor histology and grade, compared to patients with no malignant ascites those with low (HR: 1.37, 95% CI: 1.09, 1.72) and high volume ascites (HR: 1.94, 95% CI: 1.47, 2.55) had worse overall survival. Patients with low volume ascites had better survival compared to those with high volume ascites (HR: 0.71 95% CI: 0.54, 0.93) after controlling for the aforementioned confounders. Conclusions: Presence and volume of ascites at the time of primary debulking surgery may be associated with worse oncologic outcomes. Investigate the impact of malignant ascites volume on the overall survival of patients with advanced stage epithelial ovarian carcinoma who undergo primary debulking surgery and achieve complete gross resection. Patients without a history of another tumor diagnosed with stage III-IV epithelial ovarian carcinoma and bulky intra-abdominal disease between 2004-2015, who underwent primary debulking surgery followed by adjuvant chemotherapy and achieved complete gross resection were drawn from the National Cancer Database. Based on available information, the presence and volume of malignant ascites was assessed and categorized as absent, low (<980 ml) and high (≥980 ml) volume. Median overall survival was determined following generation of Kaplan-Meier curves and compared with the log-rank test. A multivariate Cox model was constructed to control for confounders. A total of 1040 patients who met the inclusion criteria were identified; 50.4% had no ascites, 34.2% had low and 15.4% had high volume malignant ascites at the time of primary debulking surgery. Median patient age was 61 years, while the majority were White (87.7%), without co-morbidities (81.1%) and had serous tumors (91.8%). Groups were comparable in terms of patient race, presence of comorbidities, tumor histology and grade. Median OS of patients without malignant ascites was 59.79 months, compared to 50.33 months for those who had low volume and 41.95 months for those who had high volume malignant ascites. After controlling for patient age, race, insurance status, presence of comorbidities and tumor histology and grade, compared to patients with no malignant ascites those with low (HR: 1.37, 95% CI: 1.09, 1.72) and high volume ascites (HR: 1.94, 95% CI: 1.47, 2.55) had worse overall survival. Patients with low volume ascites had better survival compared to those with high volume ascites (HR: 0.71 95% CI: 0.54, 0.93) after controlling for the aforementioned confounders. Presence and volume of ascites at the time of primary debulking surgery may be associated with worse oncologic outcomes.