Residual tumor and primary debulking surgery vs interval debulking surgery in stage IV epithelial ovarian cancer

Abstract

Introduction It is debated whether women with FIGO (International Federation of Gynecology and Obstetrics) Stage IV epithelial ovarian cancer should be offered primary debulking surgery (PDS) or interval debulking surgery (IDS). Furthermore, the impact of complete resection of intra‐abdominal disease (R0) despite their extra‐abdominal metastases is questioned. The objective of this study was to investigate the impact of intra‐abdominal residual tumor, Stage IVA vs IVB, the localization and number of metastases defining Stage IV disease on overall survival (OS) comparing PDS and IDS in FIGO Stage IV epithelial ovarian cancer. Material and Methods We included 2091 women registered with Stage IIIC–IV ovarian cancer in the Danish Gynecological Cancer Database during 2009–2016. The impact of residual tumor was evaluated using univariate and multivariate analyses. Results In total, 681 patients had stage IV disease, of whom 26% underwent PDS, 38% IDS, and 36% chemotherapy only. Overall survival for PDS and IDS were similar. Patients achieving R0 at PDS showed a tendency towards a higher OS than patients achieving R0 at IDS, though the difference was non‐significant. In women with Stage IVA and IVB disease there was a survival benefit in achieving R0 both when treated with PDS and IDS. Women with Stage IVB disease treated with chemotherapy only had a significantly lower OS than patients achieving R0 at both PDS and IDS. Malignant pleural effusion and having five metastatic sites compared with having one was associated with a poorer OS. Conclusions Our study shows similar OS in patients with Stage IV disease treated with IDS compared with PDS. Complete intra‐abdominal tumor resection improves the prognosis in both PDS and IDS in Stage IV ovarian cancer. Malignant pleural effusion seems to be a negative prognostic factor and should have more focus in future studies.

Maximal Effort Cytoreduction in Epithelial Ovarian Cancer: Perioperative Complications and Survival Outcomes from a Retrospective Cohort

“…In our study, the appropriate sample size was not reached to permit safe evaluation of the impact of timing of surgery in appropriately cytoreduced patients, however, descriptive statistics indicated increased intervals of overall survival the PDS group of patients. This observation has been previously confirmed by Sorensen et al in a large cohort retrieved by the Danish Gynecological Cancer Database [ 21 ]; however, even in this population-based study, the power to retrieve robust conclusions was not reached in the subgroup of appropriate cytoreduced patients.…”

Ovarian Papillary Adenocarcinoma in a Single Young Nullipara: Challenges of Management in a Low-Income Setting

“…Worldwide, ovarian cancer accounts for 3.4% of cancers associated with women with nearly 314000 new cases in 2020 [2]. Women with ovarian cancer often experience few or diffuse symptoms, and approximately 70% present in advanced stages-FIGO (International Federation of Gynecology and Obstetrics) stage III-IV at time of diagnosis [3]. The current standard of treatment is primary debulking surgery followed by six courses of platinum-based chemotherapy with the addition of a taxane (either paclitaxel or docetaxel) [3].…”

“…Women with ovarian cancer often experience few or diffuse symptoms, and approximately 70% present in advanced stages-FIGO (International Federation of Gynecology and Obstetrics) stage III-IV at time of diagnosis [3]. The current standard of treatment is primary debulking surgery followed by six courses of platinum-based chemotherapy with the addition of a taxane (either paclitaxel or docetaxel) [3]. Intra-abdominal complete tumor resection is associated with a benefit in overall survival and is considered a key part in the management of epithelial ovarian cancer [4].…”

“…Some factors noted to be associated with an increased risk of ovarian cancer include nulliparity, advancing age, and family history of the disease. Studies have shown that about two thirds of patients with ovarian tumors present in Stage 3 [1][2][3]. This may be attributed to the asymptomatic nature of the disease and the lack of effective screening methods for ovarian cancers.…”

Prediction for 2-year mortality of metastatic ovarian cancer patients based on surveillance, epidemiology, and end results database

“…This may affect the selection of treatments in stage IV ovarian cancer patients, especially in less developed regions. Many patients give up treatment in despair, some patients only choose short-term chemotherapy, and some patients choose standard surgery and chemotherapy, and the prognoses were not the same ( 13 – 15 ). The poor prognosis of metastatic ovarian cancer patients may due to the differences of patients’ metastatic sites and conditions ( 7 ).…”