Primary Debulking Surgery In Patients Research Articles

Preoperative serum level of CA153 and a new model to predict the sub-optimal primary debulking surgery in patients with advanced epithelial ovarian cancer

ObjectiveThe aim of this study was to establish a preoperative model to predict the outcome of primary debulking surgery (PDS) for advanced ovarian cancer (AOC) patients by combing Suidan predictive model with HE4, CA125, CA153 and ROMA index.Methods76 AOC Patients in revised 2014 International Federation of Gynecology and Obstetrics (FIGO) stage III-IV who underwent PDS between 2017 and 2019 from Yunnan Cancer Hospital were included. Clinical data including the levels of preoperative serum HE4, CA125, CA153 and mid-lower abdominal CT-enhanced scan results were collected. The logistics regression analysis was performed to find factors associated with sub-optimal debulking surgery (SDS). The receiver operating characteristic curve was used to evaluate the predictive performances of selected variables in the outcome of primary debulking surgery. The predictive index value (PIV) model was constructed to predict the outcome of SDS.ResultsOptimal surgical cytoreduction was achieved in 61.84% (47/76) patients. The value for CA125, HE4, CA153, ROMA index and Suidan score was lower in optimal debulking surgery (ODS) group than SDS group. Based on the Youden index, which is widely used for evaluating the performance of predictive models, the best cutoff point for the preoperative serum HE4, CA125, CA153, ROMA index and Suidan score to distinguish SDS were 431.55 pmol/l, 2277 KU/L, 57.19 KU/L, 97.525% and 2.5, respectively. Patients with PIV≥5 may not be able to achieve optimal surgical cytoreduction. The diagnostic accuracy, NPV, PPV and specificity for diagnosing SDS were 73.7%, 82.9%, 62.9% and 72.3%, respectively. In the constructed model, the AUC of the SDS prediction was 0.770 (95% confidence interval: 0.654-0.887), P<0.001.ConclusionPreoperative serum CA153 level is an important non-invasive predictor of primary SDS in advanced AOC, which has not been reported before. The constructed PIV model based on Suidan's predictive model plus HE4, CA125, CA153 and ROMA index can noninvasively predict SDS in AOC patients, the accuracy of this prediction model still needs to be validated in future studies.

Surgical evidence-based comparison of [68Ga]Ga-FAPI-04 PET and MRI-DWI for assisting debulking surgery in ovarian cancer patients.

Imaging assessment of abdominopelvic tumor burden is crucial for debulking surgery decision in ovarian cancer patients. This study aims to compare the efficiency of [68Ga]Ga-FAPI-04 FAPI PET and MRI-DWI in the preoperative evaluation and its potential impact to debulking surgery decision. Thirty-six patients with suspected/confirmed ovarian cancer were enrolled and underwent integrated [68Ga]Ga-FAPI-04 PET/MRI. Nineteen patients (15 stage III-IV and 4 I-II stage) who underwent debulking surgery were involved in the diagnostic efficiency analysis. The images of [68Ga]Ga-FAPI-04 PET and MRI-DWI were visually analyzed respectively. Immunohistochemistry on FAP was performed in metastatic lesions to investigate the radiological missing of [68Ga]Ga-FAPI-04 PET as well as its different performance in primary debulking surgery (PDS) and interval debulking surgery (IDS) patients. Potential imaging impact on management was also studied in 35 confirmed ovarian cancer patients. [68Ga]Ga-FAPI-04 PET displayed higher sensitivity (76.8% vs.59.9%), higher accuracy (84.9% vs. 80.7%), and lower missing rate (23.2% vs. 40.1%) than MRI-DWI in detecting abdominopelvic metastasis. The diagnostic superiority of [68Ga]Ga-FAPI-04 PET is more obvious in PDS patients but diminished in IDS patients. [68Ga]Ga-FAPI-04 PET outperformed MRI-DWI in 70.8% abdominopelvic regions (17/24), which contained seven key regions that impact the resectability and surgical complexity. MRI-DWI hold advantage in the peritoneal surface of the bladder and the central tendon of the diaphragm. Of the contradictory judgments between the two modalities (14.9%), [68Ga]Ga-FAPI-04 PET correctly identified more lesions, particularly in PDS patients (73.8%). In addition, FAP expression was independent of lesion size and decreased in IDS patients. [68Ga]Ga-FAPI-04 PET changed 42% of surgical planning that was previously based on MRI-DWI. [68Ga]Ga-FAPI-04 PET is more efficient in assisting debulking surgery in ovarian cancer patients than MRI-DWI. Integrated [68Ga]Ga-FAPI-04 PET/MR imaging is a potential method for planning debulking surgery in ovarian cancer patients.

Preoperative Level of Insulin-Like Growth Factor Binding Protein 2 Predicts The Suboptimal Outcome After Primary Debulking Surgery in Patients with Advance Ovarian Cancer

BACKGROUND: The need for clinically useful biomarkers which can predict the surgical outcome after primary debulking surgery (PDS) in patients with advance ovarian cancer (AOC) is really important. Insulin-like growth factor-binding protein 2 (IGFBP2) is the main binding protein expressed by ovarian cancer cells, which plays a prominent role in promoting proliferation, driving invasion, and suppressing apoptosis. This study was conducted to assess the performance of IGFBP2 in predicting the surgical outcome after PDS in patients with AOC.METHODS: Twenty-four subjects with AOC (Stage IIIc/IV) who underwent PDS were recruited consecutively. Clinicopathologic data were obtained from subjects' medical records. Blood samples were withdrawn form each subject and preoperative level of IGFBP2 were measured using enzyme-linked immunosorbent assay (ELISA). Multivariate analysis was employed to test the performance of multiple predictors of surgical outcome.RESULTS: Eighteen patients (75%) had suboptimal outcome after PDS. Mean IGFBP2 level was significantly higher in the suboptimal group (1157.5±359.9 ng/mL vs. 679.1±504.5 ng/mL, p=0.018). In bivariate model, higher preoperative level of IGFBP2 predict the suboptimal outcome with good accuracy (AUC: 0.796, sensitivity: 83.3%, specificity: 83.3%, p=0.033, optimal threshold level 870 ng/mL). Higher IGFBP2 level was associated with higher risk of suboptimal outcome, although IGFBP2 was not an independent risk factor (adjusted OR: 5.0, 95% CI: 0.43-57.9, p=0.198).CONCLUSION: IGFBP2 is a novel and promising biomarker for surgical outcome prediction following PDS in AOC patients. Since it is predictive for suboptimal outcome, patients with higher preoperative level of IGFBP2 needs more thorough preoperative evaluation as well as meticulous surgical technique to optimize the surgical outcome.KEYWORDS: IGFBP2, advance ovarian cancer, PDS, surgical outcome, predictor

Impact of the time interval between primary or interval surgery and adjuvant chemotherapy in ovarian cancer patients.

Primary debulking surgery (PDS), interval debulking surgery (IDS), and platinum-based chemotherapy are the current standard treatments for advanced ovarian cancer (OC). The time to initiation of adjuvant chemotherapy (TTC) could influence patient outcomes. We conducted a multicenter retrospective cohort study of advanced (International Federation of Gynecology and Obstetrics (FIGO) stage III or IV) OC treated between 2014 and 2018 to assess progression-free survival (PFS) and overall survival (OS) in relation to TTC. All patients underwent a germline multigene panel for BRCA1/2 evaluation. Among the 83 patients who underwent PDS, a TTC ≥ 60 days was associated with a shorter PFS (hazard ratio (HR) 2.02, 95% confidence interval (CI) 1.04-3.93, p = 0.038), although this association lost statistical significance when adjusting for residual disease (HR 1.52, 95% CI 0.75-3.06, p = 0.244, for TTC and HR 2.73, 95% CI 1.50-4.96, p = 0.001, for residual disease). Among 52 IDS patients, we found no evidence of an association between TTC and clinical outcomes. Ascites, type of chemotherapy, or germline BRCA1/2 mutational status did not influence TTC and were not associated with clinical outcomes in PDS or IDS patients. In conclusion, longer TTC seems to negatively affect prognosis in patients undergoing PDS, especially those with residual disease.

Comparison of Neoadjuvant Chemotherapy Plus Interval Debulking Surgery and Primary Debulking Surgery in Patients with Stage III and IV Ovarian Carcinoma: A Multicenter Real Life Experience

Comparison of Neoadjuvant Chemotherapy Plus Interval Debulking Surgery and Primary Debulking Surgery in Patients with Stage III and IV Ovarian Carcinoma: A Multicenter Real Life Experience

A Subset of Secreted Proteins in Ascites Can Predict Platinum-Free Interval in Ovarian Cancer.

Simple SummaryIdentifying proteins that correlate with better or worse outcomes may help to identify new treatment approaches for advanced high-grade serous ovarian cancer. Here, we utilize a machine learning technique to correlate the levels of 58 secreted proteins in tumor ascites with the time to disease recurrence after chemotherapy, which is known clinically as the platinum-free interval. We identify several candidate proteins correlated to shorter or longer platinum-free intervals and describe model analysis methods that may be useful for other studies aiming to identify factors impacting patient outcomes. Future validation of these factors in a prospective cohort would confirm their clinical utility, whereas a study of the mechanisms that they impact may identify new therapies.The time between the last cycle of chemotherapy and recurrence, the platinum-free interval (PFI), predicts overall survival in high-grade serous ovarian cancer (HGSOC). To identify secreted proteins associated with a shorter PFI, we utilized machine learning to predict the PFI from ascites composition. Ascites from stage III/IV HGSOC patients treated with neoadjuvant chemotherapy (NACT) or primary debulking surgery (PDS) were screened for secreted proteins and Lasso regression models were built to predict the PFI. Through regularization techniques, the number of analytes used in each model was reduced; to minimize overfitting, we utilized an analysis of model robustness. This resulted in models with 26 analytes and a root-mean-square error (RMSE) of 19 days for the NACT cohort and 16 analytes and an RMSE of 7 days for the PDS cohort. High concentrations of MMP-2 and EMMPRIN correlated with a shorter PFI in the NACT patients, whereas high concentrations of uPA Urokinase and MMP-3 correlated with a shorter PFI in PDS patients. Our results suggest that the analysis of ascites may be useful for outcome prediction and identified factors in the tumor microenvironment that may lead to worse outcomes. Our approach to tuning for model stability, rather than only model accuracy, may be applicable to other biomarker discovery tasks.

Systematic review and meta-analysis of neoadjuvant chemotherapy compared to primary debulking surgery in advanced endometrial cancer (538)

Systematic review and meta-analysis of neoadjuvant chemotherapy compared to primary debulking surgery in advanced endometrial cancer (538)

A New Paradigm in Managing Advanced Ovarian Cancer: Differentiating Patients Requiring Neoadjuvant Treatment from Primary Cytoreduction.

Simple SummaryThis study evaluates the comparability of patients treated with primary cytoreduction and patients undergoing neoadjuvant chemotherapy for advanced stages high grade serous ovarian carcinoma by comparing the preoperative and postoperative characteristics after a propensity score matching analysis during ten years in a tertiary cancer center.Our study aims to evaluate the comparability of primary debulking surgery (PDS) and neoadjuvant chemotherapy (NACT) patients. This single-center retrospective study includes all patients treated for advanced stages high-grade serous ovarian carcinomas (HGSOC) between 2007 and 2017. Preoperative characteristics and postoperative outcomes were compared after a propensity score matching analysis. Of the 221 patients included, 38% underwent PDS, and 62% received NACT. There was no age difference at diagnosis; however, CA125 levels, PCI score levels, and rates of stage IV were higher in the NACT group. There were no differences concerning the rate and the severity of complications (p = 0.29). The propensity score distribution showed a broad distinction between PDS patients and NACT patients with no significant overlap. Survival analyses demonstrate, after a median follow-up of 66.5 months, an overall survival (OS) of 105.9 and progression-free survival (PFS) of 29.2 months in the PDS group, compared to OS of 52.8 and PFS of 18.9 months in the NACT group. Advanced HGSOC is a heterogeneous population, in which inoperable patients should be differentiated from PDS patients based on many factors, primarily tumor burden.

Comparison of Survival Between Primary Debulking Surgery Versus Neoadjuvant Chemotherapy for Ovarian Cancers in a Personalized Treatment Cohort

ObjectiveTo compare survival between primary debulking surgery (PDS) and neoadjuvant chemotherapy (NACT) for the treatment of ovarian cancer patients per our selective protocol.MethodsBetween Sep 1st, 2015, and Aug 31st, 2017, 161 patients were enrolled in our prospective cohort. All of the patients received preoperative clinic-radiological assessments, according to the Suidan criteria for R0 resection. Patients with a score of 0–2 received PDS. Patients with a score of ≥3 were counseled on the choices of PDS, NACT, or an optional staging laparoscopy, according to the Fagotti criteria. Clinic-pathological data were prospectively collected until May 1st, 2020, and the impacts of different treatment strategies on progression-free survival (PFS) and overall survival (OS) were analyzed.Results110 patients underwent PDS, and 51 patients received NACT with consequent interval debulking surgery. The R0 resection rate was 57.8%. All but one of the patients received platinum-based chemotherapy, and 105 (65.2%) patients were platinum-sensitive. Based on the univariate analysis, the PDS group exhibited prolonged PFS compared with the NACT group (P=0.029). The subgroup analysis showed that patients receiving NACT with residual disease (RD) exhibited the worst PFS (P=0.001). Based on the multivariate analysis, NACT with RD was still an independent impaired factor for PFS (P=0.04). However, NACT did not affect OS in the univariate or multivariate analyses.ConclusionIn our prospective cohort, NACT ovarian patients exhibited inferior PFS and noninferior OS compared with PDS patients. Given our selective protocol, NACT cannot be arbitrarily denied while appropriate PDS is still a priority.

Neoadjuvant Chemotherapy Followed by Surgery versus Primary Surgery in Advanced Epithelial Ovarian Cancer: A Review of Outcomes at National Institute of Cancer Research Hospital in Bangladesh

Introduction: This study evaluated the difference in operative and clinical outcomes for patients with advanced ovarian cancer after primary debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in Bangladesh. Methods: Sixty patients with advanced epithelial ovarian cancer presenting to the department of Gynaecological Oncology at the National Institute of Cancer Research and Hospital were prospectively enrolled. Thirty patients underwent primary debulking surgery and thirty patients received NACT followed by IDS. Results: In the PDS and IDS groups respectively, 56.7% and 50% of patients presented with stage IIIC and 67.7% and 56.7% respectively had serious papillary type histopathology. Duration of surgery, amount of blood loss and total hospital stay were significantly lower (p in the PDS group. There was a statistically significant difference in postoperative tumor residuals between IDS and PDS patients. Complete tumor resection (R0) was obtained in 24 (80%) of IDS patients versus 13 (43.3%) PDS patients. In fifteen months of follow-up, 21 (70%) in the PDS group and 5 (16.7%) in the IDS group recurred (p = 0.021). Median progression free survival in PDS patients was twelve months while that of the IDS group was seventeen months. There was one death at 45 days in the PDS group. No other deaths were documented at fifteen months of follow-up. Conclusion: Interval debulking surgery has a more favorable outcome than primary debulking surgery on progression free survival in advanced ovarian cancer patients and permits a less aggressive surgery to be performed in Bangladesh.

Appropriate triage allows aggressive primary debulking surgery with rates of morbidity and mortality comparable to interval surgery after chemotherapy

ObjectiveMorbidity and mortality (M/M) after primary debulking surgery (PDS) is often cited as a rationale for neoadjuvant chemotherapy and interval debulking surgery (IDS). We tested if using an evidence-based algorithm to identify patients fit for surgery would reduce M/M after PDS to that seen after IDS. MethodsWe included women who underwent PDS or IDS for advanced epithelial ovarian cancer (EOC) (1/2012–7/2016) guided by the use of a prospective triage algorithm. Outcomes were compared after applying inverse-probability of treatment weighting (IPTW) to adjust for covariate imbalance. ResultsOf 334 included patients, 232 (69.5%) underwent PDS and 102 (30.5%) were triaged to IDS. Relative to IDS group, PDS patients were younger (63.9 vs 67.5 years, P=0.01), were less likely to have low albumin (16.8% vs. 32.4%, P<0.001), had longer median operative times (315 vs 263 min, P <0.001), more high complexity surgeries and fewer low complexity surgeries (27.2% vs. 11.8% and 18.5% vs 36.3% respectively, P<0.001). The rates of the following outcomes were comparable for PDS and IDS, respectively: successful cytoreduction (complete, 62.5% vs 66.7%, P=0.47 and optimal, 95.3% vs 98.0%, P=0.36), 30-day grade 3+ complications (IPTW-adjusted 18.3% vs. 12.9%, P=0.22), 90-day mortality (IPTW-adjusted, 2.2% vs. 3.8%, P=0.42), length of hospitalization (P=0.29), and postoperative chemotherapy delivery (P=0.83). 3-year overall survival was higher for PDS group (IPTW-adjusted 64.1% vs. 42.6%, P=0.001). ConclusionsUse of our validated triage strategy allowed us to offer 70% of women with advanced EOC PDS surgery. Despite more complex surgery, M/M after this approach is low and comparable to IDS, with similar rates of complete resection and superior OS. Use of a validated triage system should be utilized when considering PDS vs neoadjuvant chemotherapy.

Systemic and intratumoral stress responses to primary debulking surgery in patients with epithelial ovarian cancer

Objective: There is evidence suggesting that surgical procedures may facilitate tumor growth and promote metastases because of paracrine and neuroendocrine stress response, which increases proangiogenic factors, suppresses antitumor immunity, and facilitates malignant cell invasion and proliferation. We sought to determine whether a protumorigenic stress response occurs in the course of ovarian cancer (OC) cytoreductive surgery and to define its impact on the tumor and tumor microenvironment.

Similar Overall Survival Using Neoadjuvant Chemotherapy or Primary Debulking Surgery in Patients Aged Over 75 Years with High-Grade Ovarian Cancer.

To perform a hypothesis-generating evaluation of patient outcomes following neoadjuvant chemotherapy (NACT) compared with those following primary debulking surgery (PDS) in patients over age 75 with high-grade ovarian cancer. This was a retrospective cohort study of consecutive patients aged 75 years and older, with high-grade ovarian cancer. Data were analyzed in SPSS 25.0 using descriptive statistics to characterize groups based on primary treatment modality, Kaplan-Meier survival curves to estimate overall and progression-free survival, and Cox proportional hazards to analyze confounders. Of 429 patients with stages III and IV high-grade ovarian cancer (endometrioid and serous), 71 were aged older than 75 years and met our criteria for inclusion; 58 were treated with NACT while 13 underwent primary debulking. Sixteen patients did not undergo interval debulking following NACT. There were no significant differences in demographic characteristics between the groups. Following NACT, more patients were completely debulked-36.2% versus 21% (P=0.000)-and had a shorter length of stay (5 vs. 7 d; P=0.018). Overall survival was similar between the NACT and PDS groups (58.7 vs. 59.7 mo; LR -0.836; P=0.361) despite lower progression-free survival in the NACT group (25.9 vs. 47.1 mo; P=0.042; LR 4.31). Both progression-free and overall survival were significantly higher when patients undergoing NACT achieved complete debulking (21.7 and 102.3 mo, respectively) compared with suboptimal debulking (12.03 and 14.2 mo, respectively). In this select group older patients with stage III and IV high-grade ovarian cancers, neoadjuvant chemotherapy may be considered without compromising outcomes and contributes to complete debulking.

Neoadjuvant chemotherapy followed by interval debulking surgery versus primary debulking surgery in the advanced epithelial ovarian cancer- a retrospective cohort study

Background/Aim. The gold standard in treating the advanced ovarian cancer (AOC) is primary debulking surgery (PDS) followed by platinum-based adjuvant chemotherapy. In the AOC, the extent of tumor resection (residual tumor volume) is the most important prognostic factor for overall survival (OS) and progression-free survival (PFS). Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is an experimental treatment of the AOC, introduced in clinical practice in order to improve cytoreduction rate and prolong survival. The aim of this study was to compare the survival and cytoreduction rate of NACT+IDS and PDS in patients with the AOC. Methods. This retrospective cohort study included patients with the AOC, separated into two groups. The first group treated with PDS had 59 patients, while the second group, treated with NACT + IDS, had 33 patients. Results. A lower rate of suboptimal cytoreduction (39.39%) was found in the NACT + IDS group than in the PDS group (57.63%). The percentage of complete cytoreduction was higher in patients treated with NACT + IDS (51.52%) than in those treated with PDS (38.98%). Nevertheless, median OS and PFS were not significantly different between the groups (p &lt; 0.05). OS was 35 months and 31 months in the PDS and NACT + IDS groups, respectively. PFS was 16 months in the PDS and 19 months in the NACT + IDS group. Conclusion. Despite the higher rate of optimal debulking surgery after NACT+ IDS, survival of patients treated with method was not better than those treated with PDS. The decision for either NACT+IDS or PDS should be tailored to the individual patient.

Prognostic Significance of Systematic Lymphadenectomy as Part of Primary Debulking Surgery in Patients with Ovarian Cancer

Background: worldwide, ovarian cancer is diagnosed in more than 200,000 women yearly and accounts for over 125,000 deaths. Unfortunately, about 70% of cases are diagnosed in an advanced-stage with evidence of upper abdominal spread in approximately half of these. Aim of the Work: was to review the surgical management of female patients with ovarian cancer including intraperitoneal complete cytoreduction and systematic lymphadenectomy to show prognosis, post operative morbidities, recurrence and follow up. Patients and Methods: this study was conducted at Al-Azhar university hospitals and El Agousa police hospital – Ministry of interior - on 20 female patients who suffered from different stages of epithelial ovarian cancer with stage II, none bulky stage III, and only One patient with bilateral ovarian cancer stage Ic. Results: This is study conducted on female patients with ovarian cancer the mean age of the studied patients was 51.35 years ranging from 37-64 years. 55% of patients represented with abdominal distension, 50% had abdominal pain, 40% abdominal discomfort,15% had abnormal bleeding ,65% had nonspecific GIT manifestation ,20% had urinary symptoms and 10% had back pain. Conclusion: Although the relationship between the retroperitoneal spread of lymph nodes and patient prognosis has been demonstrated in several studies. lymphadenectomy, as a routine treatment procedure in ovarian cancer, remains controversial. Moreover, systematic lymphadenectomy often prolongs operation times, which may result in additional surgical complications such as lymphocele, lymphatic obstruction, lymphocysts and lymphedema, however these complications may be alleviated, and better outcome occurred by proper intra operative and post operative management by expert gynecological oncologist involvement and leveraging adequate instruments, which can eventually improve survival.

Prognostic Significance of Systematic Lymphadenectomy as Part of Primary Debulking Surgery in Patients with Ovarian Cancer

Background: worldwide, ovarian cancer is diagnosed in more than 200,000 women yearly and accounts for over 125,000 deaths. Unfortunately, about 70% of cases are diagnosed in an advanced-stage with evidence of upper abdominal spread in approximately half of these. Aim of the Work: was to review the surgical management of female patients with ovarian cancer including intraperitoneal complete cytoreduction and systematic lymphadenectomy to show prognosis, post operative morbidities, recurrence and follow up. Patients and Methods: this study was conducted at Al-Azhar university hospitals and El Agousa police hospital – Ministry of interior - on 20 female patients who suffered from different stages of epithelial ovarian cancer with stage II, none bulky stage III, and only One patient with bilateral ovarian cancer stage Ic. Results: This is study conducted on female patients with ovarian cancer the mean age of the studied patients was 51.35 years ranging from 37-64 years. 55% of patients represented with abdominal distension, 50% had abdominal pain, 40% abdominal discomfort,15% had abnormal bleeding ,65% had nonspecific GIT manifestation ,20% had urinary symptoms and 10% had back pain. Conclusion: Although the relationship between the retroperitoneal spread of lymph nodes and patient prognosis has been demonstrated in several studies. lymphadenectomy, as a routine treatment procedure in ovarian cancer, remains controversial. Moreover, systematic lymphadenectomy often prolongs operation times, which may result in additional surgical complications such as lymphocele, lymphatic obstruction, lymphocysts and lymphedema, however these complications may be alleviated, and better outcome occurred by proper intra operative and post operative management by expert gynecological oncologist involvement and leveraging adequate instruments, which can eventually improve survival.

Intensive care admissions among ovarian cancer patients treated with primary debulking surgery and neoadjuvant chemotherapy-interval debulking surgery.

Admissions to intensive care units (ICU) are costly, but are necessary for some patients undergoing radical cancer surgery. When compared to primary debulking surgery (PDS), neoadjuvant chemotherapy (NACT) with interval debulking surgery, is associated with less peri-operative morbidity. In this study, we compare rates, indications and lengths of ICU stays among ovarian cancer patients admitted to the ICU within 30days of cytoreduction, either primary or interval. A retrospective chart review was performed of patients with stage III-IV ovarian cancer who underwent surgical cytoreduction at two large academic medical centers between 2010 and 2014. Chi square tests, Student t-tests, and Mann-U Whitney tests were used. A total of 635 patients were included in the study. There were 43 ICU admissions, 7% of patients. Compared to NACT, a higher percentage of PDS patients required ICU admission, 9.4% vs 3.9% of patients (P=0.004). ICU admission indications did not vary between PDS and NACT patients. NACT patients admitted to the ICU had comparable mean surgical complexity scores to those PDS patients admitted to the ICU, 6.2 (95%CI 5.3-7.1) vs 4.5 (95%CI 3.1-6.0) (P=0.006). Length of ICU admission did not vary between groups, PDS 2.7days (95%CI 2.3-3.2) vs 3.5days (95%CI 1.5-5.6) for NACT (P=0.936). The rate of ICU admissions among patients undergoing PDS is higher than for NACT. Among patients admitted to the ICU, indications for admission, length of stay and surgical complexity were similar between patients treated with NACT and PDS.

Survival disparity and racial differences in the use of neoadjuvant chemotherapy (NAC) compared with primary debulking surgery (PDS) in women with ovarian cancer.

e17099 Background: Studies demonstrate racial disparity in ovarian cancer survival though survival differences seem to be mitigated when patients receive similar care. We sought to identify whether racial disparity exists in the use of NAC or PDS for women with ovarian cancer. Methods: After IRB approval, all patients with epithelial ovarian cancer who received primary treatment at our institution from 2005-2016 were identified from our tumor registry. Charts were retrospectively reviewed for clinicopathologic and survival data. Categorical variables were compared with chi-squared and continuous variables with the student t-test. Kaplan-Meier was used to compare survival probabilities. Results: 302 evaluable patients were identified. 240 (79%) patients underwent PDS and 62 (21%) received NAC. Older patients, black patients, and those with stage III/IV disease were more likely to receive NAC. In a multivariate analysis controlling for stage and age, black race remained associated with NAC [OR 3.25 (95% CI 1.41-7.47), p &lt; 0.01]. In a subgroup of advanced disease, stage III patients (n = 138) were more likely than stage IV patients (n = 52) to undergo PDS (78% v 44%, p &lt; 0.01) and black patients were more likely than others to present with stage IV disease (39% v 22%, p = 0.01). NAC was utilized more frequently (48% v 24%, p &lt; 0.01) in black patients compared with all other races. In the advanced stage subgroup analysis, patients that underwent PDS had a longer PFS than those that received NAC [HR 2.21 (95% CI 1.26-3.89), p = 0.01]. Conclusions: Racial disparity exists in the selection of PDS compared with NAC for patients with ovarian cancer and this disparity persists when controlling for stage and age. The choice of NAC or PDS may result in survival disparity. Further investigation is needed to examine other reasons, such as medical co-morbidities and disease distribution, for racial disparity in management. [Table: see text]

Neoadjuvant chemotherapy is superior to primary debulking surgery in patients with presumed unresectable epithelial ovarian cancer

Objectives: We sought to: (1) identify prognostic factors in epithelial ovarian cancer (EOC) treated with neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS), and (2) compare overall (OS) and progression-free survival (PFS) between NACT for presumed unresectable disease versus suboptimal primary debulking surgery (PDS). Methods: This was a retrospective study of consecutive patients undergoing IDS after NACT at our institution from 2007 to 2013. Clinical factors were abstracted from medical records and complete clinical response (CCR) was defined as no gross disease at IDS. Survival times were estimated with the Kaplan-Meier method and compared using the log-rank test. The subset of patients receiving NACT for the indication of presumed unresectable disease were matched 1:1 on age and stage with a contemporary cohort of patients receiving suboptimal PDS between 2003 and 2011. Survival times were compared using stratified Cox models to account for the varying duration of follow-up within each matched pair. Results: Eighty-eight patients were treated with NACT/IDS, and median PFS and OS were 1.3 and 2.6 years, respectively. The following factors were associated with improved survival after NACT: normalization of CA-125 before IDS (median OS 3.0 vs 1.9 years, P = .02); age less than 65 (3.3 vs 1.9 years, P = .005); CCR at IDS (5.6 vs 2.5 years, P = .15), and no gross residual disease after IDS (2.9 vs 2.2 years, P = .06). We saw no association between survival and number of post-IDS chemotherapy cycles, 3 vs more than 3 cycles, including among those with persistently elevated CA-125 at IDS (median OS 2.2 vs 2.7 years, P = 0.63). In our matched comparison of unresectable cases treated with NACT versus suboptimal PDS, we observed a significant OS advantage for NACT (HR 0.46, 95% CI 0.23–0.92), with no significant difference in PFS. Conclusions: We saw no survival benefit with increasing duration of adjuvant chemotherapy after IDS, but selection bias likely minimizes the benefit in partial responders. Young age, clinical response, and residual disease are all likely predictors of OS. For primary EOC in which resection to residual disease less than 1 cm is unlikely, NACT is associated with longer survival than PDS. Analysis of morbidity and costs are ongoing. As these patients are likely best served by NACT, more reliable predictors of resectability are needed to better identify such cases.

Prediction of incomplete primary debulking surgery in patients with advanced ovarian cancer: An external validation study of three models using computed tomography

ObjectiveTo test the ability of three prospectively developed computed tomography (CT) models to predict incomplete primary debulking surgery in patients with advanced (International Federation of Gynecology and Obstetrics stages III–IV) ovarian cancer. MethodsThree prediction models to predict incomplete surgery (any tumor residual >1cm in diameter) previously published by Ferrandina (models A and B) and by Gerestein were applied to a validation cohort consisting of 151 patients with advanced epithelial ovarian cancer. All patients were treated with primary debulking surgery in the Eastern part of the Netherlands between 2000 and 2009 and data were retrospectively collected. Three individual readers evaluated the radiographic parameters and gave a subjective assessment. Using the predicted probabilities from the models, the area under the curve (AUC) was calculated which represents the discriminative ability of the model. ResultsThe AUC of the Ferrandina models was 0.56, 0.59 and 0.59 in model A, and 0.55, 0.60 and 0.59 in model B for readers 1, 2 and 3, respectively. The AUC of Gerestein's model was 0.69, 0.61 and 0.69 for readers 1, 2 and 3, respectively. AUC values of 0.69 and 0.63 for reader 1 and 3 were found for subjective assessment. ConclusionsModels to predict incomplete surgery in advanced ovarian cancer have limited predictive ability and their reproducibility is questionable. Subjective assessment seems as successful as applying predictive models. Present prediction models are not reliable enough to be used in clinical decision-making and should be interpreted with caution.