Advanced Epithelial Ovarian Carcinoma Research Articles

Role of CD44 and CD24 Expression on 2-years Disease Free Survival in Patients with Advanced Epithelial Ovarian Carcinoma.

Ovarian cancer is one of the most common cancers with a high mortality rate worldwide. Despite optimal surgical therapy and chemotherapy, recurrence is still common. Cancer stem cells expressing CD44 and CD24 are thought to be contributing factors in recurrence. A cohort retrospective study with survival analysis was carried out on advanced ovarian cancer patients who underwent optimal debulking surgery followed by 6 cycles of chemotherapy at Cipto Mangunkusumo General Hospital and Fatmawati General Hospital from January 2019 to March 2023. Immunohistochemical examination was performed on tumor tissue with CD44 and CD24 expression were assessed using the H-Score method then determined the cut off-point expression level using the ROC curve. Furthermore, the relationship between these expression levels with the disease-free survival was assessed using the survival curve. There were 48 subjects who were included in the study. There were high expression levels of CD44 in 47.9% and CD24 in 50% of cases. High CD44 expression had mean and median survival of 13.2 ± 1.8 and 11 months (HR 5.05, 95% CI 1.84- 13.85). High CD24 expression had mean and median survival of 13.5 ± 2.4 and 7 months (HR 7.73, 95% CI 2.58 - 23.15). The combination of the two high expressions had mean and median survival of 10.44 ± 1.88 and 7 months. High expression of CD44 and CD24 will shorten the disease-free survival of patients with advanced ovarian cancer.

Confirmation of the utility of the CA-125 elimination rate (KELIM) as an indicator of the chemosensitivity in advanced-stage ovarian cancer in a "real-life setting".

The modeled CA-125 ELIMination rate constant K (KELIM) has been validated as a marker of response to chemotherapy in >12,000 patients with advanced epithelial ovarian carcinoma (EOC) treated in first-line setting enrolled in >12 clinical trials. Patient KELIM is calculable online https://www.biomarker-kinetics.org/presentation. The objective was to investigate the prognostic value of KELIM in a large real-life national cancer registry with non-selected patients. We investigated 4,025 EOC patients from the Netherlands Cancer Registry treated with neoadjuvant chemotherapy (NACT) ± followed by interval debulking surgery (IDS). Patient KELIM values were calculated in patients with ≥ 3 CA-125 measurements during NACT. KELIM was standardized with a pre-specified cut-off and scored as unfavorable/favorable (<1.0/≥1.0). KELIM's prognostic value regarding radiological response, completeness of IDS, progression-free survival (PFS), and overall survival (OS) was assessed using univariate/multivariate analyses. The data from 1,582 patients treated with heterogeneous chemotherapy regimens and sequences were assessable. KELIM was prognostic for radiological response and the likelihood of complete IDS after NACT (odds ratio=2.59; 95% confidence interval [CI]=2.04-3.29). Moreover, KELIM was independently associated with PFS (hazard ratio [HR]=0.76; 95% CI=0.66-0.87), and OS (HR=0.79; 95% CI=0.69-0.91). Combining KELIM with the completeness of the IDS resulted in 3 prognostic groups (satisfactory, intermediate, and poor) with significant OS differences, namely a good, intermediate, and poor survival respectively. The value of KELIM, as a pragmatic indicator of response to chemotherapy, was maintained in a large real-life population-based cohort, highlighting its applicability in routine conditions.

Impact of delayed interval cytoreductive surgery on the survival of patients with advanced stage high-grade epithelial ovarian carcinoma

ObjectiveOur objective was to use real-world data to investigate the impact of delayed interval cytoreductive surgery on the survival of patients with advanced stage high-grade ovarian carcinoma.MethodsWe accessed the National...

Combined Interval Cytoreductive Surgery and Carboplatin-Based Hyperthermic Intraperitoneal Chemotherapy in Advanced Primary High-Grade Serous Ovarian Cancer.

Combining interval cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival in advanced epithelial ovarian carcinoma (EOC). Although limited, growing evidence regarding carboplatin-based HIPEC highlights its potential. This retrospective study included all patients with advanced primary high-grade serous ovarian cancer who underwent interval CRS combined with carboplatin-based HIPEC at our Canadian tertiary care center between 2014 and 2020. We identified 40 patients with a median age of 61 years. The median peritoneal cancer index was 13 and complete cytoreduction was achieved in 38 patients (95%). Median hospital stay was 13 days and there were four admissions to the intensive care unit (10%) and six readmissions (15%). Severe adverse events occurred in eight patients (20%) and there was no perioperative death. Recurrence was seen in 33 patients (82%) with a median DFS of 18.0 months and a median overall survival of 36.4 months. Multivariate analyses showed that age, peritoneal cancer index, completeness of cytoreduction, occurrence of severe complications, and bowel resection did not significantly impact DFS or OS in our cohort. Interval CRS combined with carboplatin-based HIPEC for advanced primary EOC is associated with acceptable morbidity and oncological outcomes. Larger studies are required to determine the long-term outcomes.

779P Assessment of the RAD51 test to determine homologous recombination deficiency (HRD) in patients (pts) with newly diagnosed advanced high-grade epithelial ovarian cancer carcinoma (HGOC)

779P Assessment of the RAD51 test to determine homologous recombination deficiency (HRD) in patients (pts) with newly diagnosed advanced high-grade epithelial ovarian cancer carcinoma (HGOC)

Higher rates of neo-adjuvant chemotherapy use among high-risk patients with advanced stage epithelial ovarian carcinoma is associated with improved outcomes (1235)

Higher rates of neo-adjuvant chemotherapy use among high-risk patients with advanced stage epithelial ovarian carcinoma is associated with improved outcomes (1235)

Post-operative residual disease and number of cycles of neoadjuvant chemotherapy in advanced epithelial ovarian carcinoma

BackgroundThe optimal number of neoadjuvant chemotherapy cycles in patients with advanced ovarian cancer is still disputed.ObjectiveTo evaluate the impact of the number of neoadjuvant chemotherapy cycles and role of optimal...

Cytoreductive Surgery with HIPEC as Primary Treatment for Advanced Epithelial Ovarian Carcinoma: Upfront or Interval-ISPSM Collaborative Study.

Cytoreductive surgery with HIPEC has shown promising results in the interval setting of advanced epithelial ovarian cancer. Its role in upfront setting has not yet been established. All eligible patients underwent CRS-HIPEC as per institution protocol. Relevant data was collected prospectively in institutional HIPEC registry and analyzed retrospectively for the study period from February 2014 to February 2020. Out of 190 patients, 80 underwent CRS-HIPEC in upfront setting and 110 in interval setting. The median age was 54 ± 7.45years, upfront group had higher PCI (14.1 ± 8.75 vs. 9.6 ± 5.2. 2), and required longer duration of surgery (10.6 ± 1.73 vs. 8.4 ± 1.71h) had more blood loss (1025 ± 668.76 vs. 680 ± 302.23ml). The upfront group required more diaphragmatic resections, bowel resections, and multivisceral resections. The overall G3-G4 morbidity was comparable (25.4% vs. 27.3%), upfront group had more surgical morbidity (20% vs. 9.1%) whereas interval group had more medical morbidity, i.e., electrolyte imbalance and hematological. After a median follow-up of 43months, median DFS was 33months in the upfront vs. 30months in the interval group, p = 0.75, median OS was 46months interval group and was not yet achieved in upfront group.(p = 0.13). Four-year OS was 85% vs. 60%. In patients of advanced EOC upfront CRS HIPEC showed promising outcomes and trend towards better survival with similar morbidity and mortality. The upfront group had more surgical morbidity whereas interval group had more medical morbidity. Multiinstitutional randomized studies are needed to define patient selection and study morbidity patterns and compare the outcomes between CRS-HIPEC in the upfront and interval setting for advanced epithelial ovarian cancer.

Malignancy Risk Index 4 (RMI 4) is better than RMI 3 as a predictor Advanced Epithelial Ovarian Carcinoma was used for NACT

Of the 4 cancers in women, ovarian carcinoma is the first cause of death. The low survival rate in patients with advanced stages requires early detection to improve treatment outcomes. The methods currently used to determine whether a patient can be given neoadjuvant chemotherapy are ascites cytology and laparoscopy.This study aims To compare RMI 4 and RMI 3 as a non-invasive method in determining preoperative NACT administration. The method used is RMI 3 and RMI 4 diagnostic scoring where this method can be used as a predictor of advanced epithelial ovarian carcinoma in the interest of NACT. An analytical observational study with a retrospective cross sectional type study with samples of all patients suffering from ovarian cancer for the past 5 years, from January 2016 to January 2020 who had been diagnosed at the Gynecology Polyclinic RSUD dr. Saiful Anwar. The number of initial samples of this study was 253 women, but after being included in the inclusion criteria, there were 106 samples. After staging by an authorized clinician, there were 48 patients with early stage and 58 patients with advanced stage. Between the results of the RMI score and the histopathological results on the ROC curve, it was found that the accuracy value of RMI 3 is 84.9% and the accuracy value of RMI 4 is 86.8%. It can be concluded that RMI 4 is better than RMI 3 as a predictor of advanced ovarian carcinoma to determining preoperative NACT administration.

Peritoneal metastasis of advanced epithelial ovarian carcinoma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: A retrospective international multicentric data analysis

IntroductionThe purpose of our study was to evaluate outcome data after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal metastasis originating from advanced epithelial ovarian carcinoma (PMOC). Patients and methodsA retrospective international multi-institutional registry was established through collaborative efforts of participating units affiliated with the Peritoneal Surface Oncology Group. ResultsOne thousand four hundred and ninety-one patients from 11 specialized units underwent CRS and HIPEC that of those 326 (21.9%) upfront surgeries, 504 (33.8%) interval surgery, and 661(44.3%) recurrent cases. Complete Cytoreduction(CC0/1) was achieved in 1213 patients (81.3%). Treatment -related mortality was 0.8%, major operative complications (Grades 3–5) was 25.1%. Factors associated with major operative complications include prior surgical score (PSS for recurrent cases; RC) PSS>2,p = 0.000), PCI(≤15, >15 cut-off level; p ≤ 0.000), completeness of cytoreduction (CC, p=0.000), high CA125 levels (>25 mg/dl), presence of ascites, high CRP (>5 mg/dl) levels and low albumin levels (below to 2.5 mg/dl) (p ≤ 0.05).The median survival was 58 months in upfront surgery(UFS), 60 months in interval surgery(IS), and 42 months in RC. The overall survival for five years was 45% for UFS, 37% for IS, 28% for RC cases. CCscore (p = 0.000), CA125, CRP and albumin levels (p ≤ 0.05) were predictors for progression free survival. PCI(p ≤ 0.000), major postoperative complications (p = 0.004), incomplete CRS(CC2/3)(p < 0.001), prior chemotherapy (hazard ratio [HR], 3–8; p < 0.001) and PSS>2 for RC were independent predictors of poor overall survival. ConclusionThe combined treatment strategy for PMOC may be performed safely with acceptable morbidity and mortality in the specialized units.

Chemotherapy-Induced Neutropenia as a Prognostic Factor in Patients With Advanced Epithelial Ovarian Carcinoma.

To evaluate the prognostic value of chemotherapy-induced neutropenia (CIN) in epithelial ovarian carcinoma (EOC) treated with primary surgery followed by platinum-based chemotherapy. The records of primary EOC treated between Jan 1st 2002 and Dec 31st 2016 were reviewed according to the including and excluding criteria. CIN was defined as absolute neutrophil count (ANC) after chemotherapy <2.0 × 109/L. Patients with CIN were further divided into mild and severe CIN (ANC <1.0 × 109/L), early-onset and late-onset (>3 cycles) CIN. Clinical characteristic was compared by chi-square test. Overall survival (OS) and progression-free survival (PFS) were compared using Kaplan-Meier analysis, univariate and multivariate Cox regression models. Among 735 EOC patients enrolled, no significant differences of the prognosis were found between patients with and without CIN, early and late CIN, mild and severe CIN. However, Kaplan-Meier curve (65 vs 42months for CIN vs non-CIN, P = .007) and Cox regression analysis (HR 1.499, 95% CI 1.142-1.966; P = .004) both revealed that CIN was significantly related with better OS in advanced EOC patients, but not for PFS. So, subgroup analysis was further conducted and date suggested that CIN was an independent predictor of better survival in advanced EOC with suboptimal surgery (PFS: 18 vs 14months, P = .013, HR 1.526, 95% CI 1.072-2.171, P = .019; OS: 37 vs 27 months, P = .013, HR 1.455, 95% CI 1.004-2.108; P = .048). CIN might be used as an independent prognostic indicator of advanced EOC, especially for those patients with suboptimal surgery.

Facility level variation in the utilization of neoadjuvant chemotherapy is associated with higher surgical morbidity for patients with advanced stage epithelial ovarian carcinoma

ObjectiveInvestigate outcomes for advanced stage epithelial ovarian cancer (EOC) patients based on facility-level utilization of neoadjuvant chemotherapy (NACT). MethodsStage III-IV EOC patients diagnosed between 2010 and 2016 were identified in the National Cancer Database. Percentage of patients managed with NACT was calculated for facilities, reporting ≥120 patients. Facilities with lowest and highest quartile of NACT rate comprised the low and high-utilizing groups. Clinico-pathological characteristics were collected, and appropriate statistical analysis performed. ResultsHigh- and low-utilizing facilities managed on average 54.1% and 25.4% of patients with NACT respectively. Patients managed at high-utilizing facilities were significantly more likely to be >65 (p = 0.029), have stage IV disease (p < 0.001) and comorbidities (p < 0.001). Patients managed with primary debulking surgery (PDS) at low-utilizing facilities were significantly more likely to be >65, have stage IV disease, and have comorbidities (all, p < 0.001). Patients undergoing PDS at low-utilizing facilities were significantly less likely to achieve complete gross resection (p < 0.001), and were significantly more likely to experience 90-day mortality (p < 0.001), and unplanned 30-day readmission (p < 0.001). After controlling for age, comorbidities, race, insurance status, stage, grade and histology, high-utilizing facilities trended towards better overall survival (OS) (HR: 0.92, 95% CI: 0.85–0.99). Overall, patients undergoing PDS had better OS compared to those who had NACT (median 42 vs 27 months, p < 0.001). ConclusionsDespite treating an EOC population with more advanced disease and comorbidities, high-utilizing facilities have lower surgical morbidity and mortality with no detrimental impact on long-term survival. Careful patient selection to minimize the morbidity and mortality associated with PDS is pivotal.

Facility level variation in the adoption of neo-adjuvant chemotherapy is associated with higher surgical morbidity for patients with advanced stage epithelial ovarian carcinoma (558)

Facility level variation in the adoption of neo-adjuvant chemotherapy is associated with higher surgical morbidity for patients with advanced stage epithelial ovarian carcinoma (558)

Review of neoadjuvant chemotherapy characteristics in advanced epithelial ovarian cancer: experience from two cancer centers

Background: This study aimed to review the characteristics and survival of patients with Advanced Epithelial Ovarian Cancer undergoing neoadjuvant chemotherapy (NACT) and the impact of timing of surgery and post-operative adjuvant chemotherapy (CCT). Methods: Retrospective multicentre study, of patients with an initial diagnosis of advanced high-grade epithelial ovarian carcinoma, considered inoperable at diagnosis and treated with NACT. Results: Eighty-six patients were analyzed. Fifty-seven underwent surgery, with significantly higher median overall survival (mOS) versus those who were never operated. The percentage of complete surgery (R0) was 74%, with a median progression-free survival (mPFS) of 45 months and mOS of 67 months versus mPFS of 27 months and mOS of 28 months in patients with residual disease. Of the operated patients, 21 underwent 3–4 cycles of NACT and 36 5–6 cycles of NACT, with a mOS of 64 months and 38 months respectively. Patients with almost complete/complete NACT response had significantly improved PFS and OS compared with patients with partial/minimal/absent response. Twenty-two patients underwent 2–3 cycles CCT with no significant differences in terms of PFS or OS. COX regression showed that both the increase in time between NACT and surgery and the chemotherapy response score are related to the risk of death. Conclusions: Complete surgery and Chemotherapy Response Score (CRS) were the most important prognostic factors for survival in this population. The use of CCT showed no advantage in survival outcomes. Prospective studies are needed to evaluate new therapeutic strategies for patients with inoperable ovarian cancer at diagnosis.

Risk Of Malignancy Index 4 Performance as a Predictor Advanced Stage Epithelial Ovarian Carcinoma Used for Neoadjuvant Chemotherapy

The relatively low survival rate in patients with advanced-stage carcinoma ovaries requires early detection to improve treatment outcomes. The method currently used to determine the administration of neoadjuvant chemotherapy is ascites cytology and laparoscopic. This study aims to find a non-invasive technique in determining preoperative Neoadjuvant Chemotherapy administration, and that method can use as a predictor of advanced epithelial ovarian carcinoma. The benefit of this study is to help clinicians consider administering neoadjuvant chemotherapy with a Risk Of Malignancy Index 4 score. An analytical observational study with a retrospective cross-sectional type study with samples of all patients from January 2016 to January 2020 diagnosed at the dr. Saiful Anwar Hospital in Malang indonesia. The number of initial samples of this study is 106 samples. Between the results of the Risk Of Malignancy Index 4 score and the histopathological results, it finds that the p-value was less than 0.05 (p&lt;0.05) indicates that the Risk Of Malignancy Index 4 score is very good for predicting advanced epithelial ovarian carcinoma. With a sensitivity of 86,2%, specificity of 87,5%, the cut of value Risk Of Malignancy Index 4 to be a predictor of advanced ovarian carcinoma is 2982. This study indicates that the Risk Of Malignancy Index 4 score is excellent for predicting the stage of Epithelial Ovarian Carcinoma. This cut-off value can reference preoperative neoadjuvant therapy to avoid morbidity and mortality due to the high risk of surgery.

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

ObjectivesTo investigate the impact of malignant ascites volume on the outcomes of patients with advanced epithelial ovarian carcinoma who undergo primary debulking surgery.MethodsPatients diagnosed with stage III–IV epithelial ovarian carcinoma...

Sarcopenia is a predictor of chemotherapy response score at the time of interval debulking surgery in advanced epithelial ovarian carcinoma

<h3>Objectives:</h3> To examine the relationship between sarcopenia as measured by skeletal muscle index (SMI) on CT and chemotherapy outcomes and pathologic response after neoadjuvant chemotherapy (NACT) in patients with advanced epithelial ovarian carcinoma (EOC). <h3>Methods:</h3> Our institutional database was retrospectively queried for all women with advanced EOC who underwent NACT between 2007-2020. Demographic and clinical variables including number of NACT cycles, dose reductions, and dose delays were collected. Treatment response by 3-tier pathologic chemotherapy response score (CRS) and residual disease at time of interval cytoreductive surgery were recorded. Pre-treatment and post-treatment contrast enhanced CT scans were reviewed by two subspecialty radiologists to determine baseline and post-treatment SMI. SMI was calculated by dividing total psoas muscle and paraspinal muscle area (m²) (measured at the level of L4 vertebrae by height (cm²) squared. Patients were stratified to account for change in SMI after NACT and grouped into patients with >2% decrease in SMI (group 1) and increase or ≤2% decrease in SMI (group 2). SMI was also analyzed as a continuous variable for association with demographic and clinical factors by Kruskal-Wallis test/Spearman's correlation (results summarized as median [25th, 75th percentiles]). <h3>Results:</h3> Among 77 patients who met inclusion criteria, there were no significant differences between stage at diagnosis, baseline performance status, frailty scores, number of NACT cycles, histology, or tumor grade between the two groups. However, pretreatment Ca125 was higher in patients in group 2 (p=0.031). When SMI was analyzed as a continuous variable, age at diagnosis was negatively associated with higher SMI (-0.47, (-0.63, -0.28, p=<0.001). Number of completed NACT cycles was negatively associated with higher SMI -0.23 (-0.43, -0.0, p=0.048). Lower CRS, indicating no/minimal chemotherapy response at the time of interval cytoreduction was associated with lower SMI (0.45, (0.01, 0.75), p=0.043) despite no difference in residual disease. <h3>Conclusions:</h3> Sarcopenia as measured by SMI is associated with older age and increased number of NACT cycles in our patient population. Additionally, sarcopenia was predictive of lower chemotherapy response at the time of interval cytoreduction. Data collection is ongoing to further delineate the relationship between sarcopenia and response to NACT.

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

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.

Impact of systematic lymphadenectomy at the time of interval debulking surgery on the survival of patients with advanced-stage epithelial ovarian carcinoma following neoadjuvant chemotherapy

<h3>Objectives:</h3> In light of evidence from the LION trial, we aimed to evaluate the impact of systematic lymphadenectomy (LN) at the time of interval debulking surgery (IDS) for patients with advanced stage epithelial ovarian carcinoma. <h3>Methods:</h3> Patients with stage III-IV epithelial ovarian carcinoma without a history of another tumor who underwent neoadjuvant chemotherapy and underwent interval debulking with complete gross resection (CGR) were identified in the National Cancer Database (2010-2015). Based on pathology report patients who did not undergo any lymphadenectomy and those who underwent systematic lymphadenectomy (defined as at least 20 lymph nodes removed) were selected for further analysis. Median overall survival was compared with the log-rank test and a Cox multivariate model was constructed to control for confounders. <h3>Results:</h3> A total of 1060 patients who met the inclusion criteria were identified. Median patient age was 64 years while the majority had serous tumors (95.8%) and did not have co-morbidities (79.2%). Systematic LND was performed for 125 (11.8%) patients with a median of 29 LNs (range 20-72) removed. Rate of positive LNs was 62.4%, while median number of positive LN was 5 (range 1-28). Patients who underwent systematic LND had higher rate of unplanned readmission (8.9% vs 1.6%, p<0.001), and median hospital stay (6 vs 4 days, p<0.001). Median OS for patients who did not undergo LND was 40.38 months compared to 44.19 for those who underwent systematic LND, p=0.40. After controlling for patient age, insurance status, race, presence of comorbidities, tumor histology, and disease stage, performance of systematic LND was not associated with better survival (HR: 0.98, 95% CI: 0.80, 1.19). Lastly, median overall survival of patients with positive LNs (n=78) was 40.05 months. <h3>Conclusions:</h3> Systematic lymphadenectomy is rarely performed at the time of interval debulking surgery and was not associated with a survival benefit.

Impact of facility-volume on achieving a textbook oncologic outcome following primary debulking surgery for advanced-stage epithelial ovarian carcinoma

<h3>Objectives:</h3> Composite outcomes have emerged as a more accurate marker of optimal oncologic care. We evaluated the impact of facility-volume on achieving a ‘textbook oncologic outcome' (TOO) among patients diagnosed with advanced stage epithelial ovarian carcinoma (EOC) undergoing primary debulking surgery (PDS) followed by adjuvant chemotherapy. <h3>Methods:</h3> Patients diagnosed between 2004-2015 with stage IIIC-IV EOC who underwent PDS at the reporting facility followed by adjuvant chemotherapy were identified in the National Cancer Database. Annual facility PDS volume was calculated and high-volume facilities were defined those performing at least 12 PDS per year. TOO was defined as achievement of complete gross resection (CGR), no 90-day mortality, no prolonged hospitalization (>10 days), no unplanned readmission within 30-days from discharge, and initiation of adjuvant chemotherapy within 42 days from surgery and evaluated among patients with available data for all variables. Median overall survival (OS) was compared with the log-rank test and a Cox multivariate model was constructed to control for confounders. <h3>Results:</h3> A total of 19875 patients were used to calculate annual PDS facility-volume. Final analysis cohort included 6984 patients with available data for all variables of interest; 14.8% were managed at a high-volume center. A TOO was achieved for 1764 (25.3%) patients. Rate of CGR was 42.8%, while rate of prolonged hospitalization was 15.2%. Unplanned re-admission (8%) and death within 90-days (1.4%) were rare, while 28.6% of patients experienced a delay in chemotherapy administration. Patients managed at high-volume centers were more likely to achieve a TOO (28.1% vs 24.8%, p=0.022). After controlling for age, race, insurance, and comorbidities, PDS at a high-volume center was associated with a higher likelihood of achieving a TOO (OR: 1.17, 95% CI: 1.01, 1.36). Median OS of patients who did and did not achieve a TOO was 58.45 and 42.51 months respectively, p<0.001. After controlling for histology, stage, comorbidities, patient age, race, and type of insurance, TOO was associated with better survival (HR: 0.64, 95% CI: 0.59, 0.70). <h3>Conclusions:</h3> PDS at a high-volume center was associated with superior oncologic outcomes for patients with advanced-stage EOC. Centralization of care of these patients to centers of excellence should be considered.