Ovarian cancer patients selected for neoadjuvant chemotherapy vs. primary debulking surgery are not similar — A national cancer data base study

Abstract

Objectives: The aim of this study was to determine the impact that obesity has on surgical and oncologic outcomes after primary debulking surgery (PDS) in advanced epithelial ovarian cancer (EOC). Methods: The medical records of women with stage IIIC/IV EOC who underwent PDS with curative intent between 1/1/2003 and 12/31/ 2011 were retrospectively reviewed. Postoperative complications within 30 days were graded according to the modified 4-point Accordion classification. For statistical analyses patients were divided into three weight groups according to body mass index (BMI) as follows: Group 1–BMI b30.0 kg/m; Group 2–BMI 30.0–39.9 kg/m; and Group 3–BMI ≥40.0 kg/m. Logistic regression models were fit to evaluate the associations between weight group and categorical outcomes. Cox proportional hazards models were fit to evaluate the associations with 90-day mortality, overall survival (OS) and progression-free survival (PFS). Results: Of the 620 patients included in the study, 67.1%, 26.5%, and 6.5% were in weight groups 1, 2, and 3, respectively. Patients in group 3 were significantly younger (mean age, 60.7 vs. 65.1 years, p = 0.02) andmore likely to have an ASA score≥3 (67.5% vs. 42.0%, p = 0.002) compared to patients in group 1. Weight group 3 was an independent predictor of severe (grade 3 or 4) 30-day complications after adjusting for ASA score, surgical complexity, age, and preoperative albumin (group 3 vs. group 1: odds ratio 2.52, 95% CI 1.19, 5.31; p= 0.02). Weight group was not associated with differences in residual disease (p= 0.78) or surgical complexity (p= 0.08). Ninety-day mortality was 9.7%, 6.3%, and 15.7% in weight groups 1, 2, and 3, respectively (p= 0.17). After adjusting for confounders, this association approached statistical significance (p = 0.07). There was no difference in OS (p= 0.53) or PFS (p= 0.71) among weight groups. Conclusion: This is one of the largest studies to examine the impact of obesity on advanced EOC, and the only to analyze patients with a BMI ≥40.0 kg/m2. BMI ≥40.0 kg/m is an independent predictor of severe 30-day postoperative morbidity after primary debulking surgery for EOC – information useful in preoperative counseling. BMI does not appear to impact long-term oncologic outcomes or residual disease at primary surgery. Risk-adjustment models and reimbursement strategies should incorporate these observations.