Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment

Giovanni D. Aletti, Eric L. Eisenhauer, Antonio Santillan, Allison Axtell, Giacomo Aletti, Christine Holschneider, Dennis S. Chi, Robert E. Bristow, William Arthur Cliby

Research output: Contribution to journalArticle

123 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)23-28
Number of pages6
JournalGynecologic Oncology
Volume120
Issue number1
DOIs
StatePublished - Jan 2011

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Social Identification
Ovarian Neoplasms
Morbidity
Therapeutics
Neoplasms
Survival
Nutritional Status
Drug Therapy
Mortality
Health

Keywords

  • Age
  • Ovarian cancer
  • Prognostic factors
  • Risk adjusted model
  • Surgery
  • Tumor load

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment. / Aletti, Giovanni D.; Eisenhauer, Eric L.; Santillan, Antonio; Axtell, Allison; Aletti, Giacomo; Holschneider, Christine; Chi, Dennis S.; Bristow, Robert E.; Cliby, William Arthur.

In: Gynecologic Oncology, Vol. 120, No. 1, 01.2011, p. 23-28.

Research output: Contribution to journalArticle

Aletti, GD, Eisenhauer, EL, Santillan, A, Axtell, A, Aletti, G, Holschneider, C, Chi, DS, Bristow, RE & Cliby, WA 2011, 'Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment', Gynecologic Oncology, vol. 120, no. 1, pp. 23-28. https://doi.org/10.1016/j.ygyno.2010.09.010
Aletti, Giovanni D. ; Eisenhauer, Eric L. ; Santillan, Antonio ; Axtell, Allison ; Aletti, Giacomo ; Holschneider, Christine ; Chi, Dennis S. ; Bristow, Robert E. ; Cliby, William Arthur. / Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment. In: Gynecologic Oncology. 2011 ; Vol. 120, No. 1. pp. 23-28.
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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.",
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AU - Chi, Dennis S.

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