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Complex Surgery Does Not Independently Predict Outcome in Advanced Ovarian Cancer

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Key Points

  • Residual disease and preoperative disease burden were significantly associated with progression-free and overall survival among patients with advanced ovarian cancer.
  • On multivariate analysis, complexity of surgery was not predictive of progression-free or overall survival.

In an analysis in the Gynecologic Oncology Group (GOG 182) trial population reported in the Journal of Clinical Oncology, Horowitz et al found that more complex surgery was not an independent predictor of progression-free or overall survival among patients with advanced epithelial ovarian or primary peritoneal cancer.

Study Details

The analysis involved 2,655 patients from GOG 182 who underwent surgery to achieve complete resection (R0) or < 1 cm residual disease (MR). Of them, 2,364 patients had stage III and 291 had stage IV disease; 860 patients achieved R0, and 1,795 had MR disease; preoperative disease burden assessed by disease score was low in 173, moderate in 845, and high in 1,637surgery complexity assessed by complexity score was low in 456, moderate in 1,770, and high in 429.

MR Disease and Higher Disease Burden Predict Outcome

Median progression-free (15 vs 29 months, P < .01) and overall survival (41 vs 77 months, P < .01) were worse in patients with MR disease vs R0 patients. Compared with patients with low and moderate preoperative disease burdens, those with a high disease score had shorter progression-free survival (15 vs 23 and 34 months, P < .01) and overall survival (40 vs 71 and 86 months, P < .01). Poorer outcome in patients with a high preoperative disease burden was also observed among patients with R0 for both progression-free survival (18.3 vs 33.2 months for moderate or low disease score, P < .001) and overall survival (50.1 vs 82.8 months, P < .001).

Effect of Complex Surgery

Patients who had more complex surgical procedures had shorter progression-free survival than did those with moderate and low complexity scores (14.9 vs 18.0 and 18.5 months, P < .001), with no differences in overall survival being observed among the three groups. In multivariate analysis adjusting for preoperative disease score, residual disease, an interaction term for disease score/complexity score, performance status, age, and cell type, surgery complexity score was not significantly associated with either progression-free or overall survival (P > .13 for both).

The investigators concluded: “In this large multi-institutional sample, initial disease burden remained a significant prognostic indicator despite R0. Complex surgery does not seem to affect survival when accounting for other confounding influences, particularly [residual disease].”

Larry Maxwell, MD, of Inova Women’s Hospital, Falls Church, Virginia, is the corresponding author of the Journal of Clinical Oncology article.

The study was supported by National Cancer Institute grants. The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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