TY - JOUR
T1 - Improved survival after implementation of ultra-radical surgery in advanced epithelial ovarian cancer
T2 - Results from a tertiary referral center
AU - Norppa, Niina
AU - Staff, Synnove
AU - Helminen, Mika
AU - Auranen, Annika
AU - Saarelainen, Sami
N1 - Funding Information:
This study was financially supported by Tampere University Hospital (grant ID MJ006B/2020. The authors would like to thank the Clinical Informatics Unit at the Tampere University Hospital for data curating, visualization, and analysis.
Publisher Copyright:
© 2022
PY - 2022
Y1 - 2022
N2 - Objective: To compare survival rates of surgically treated advanced epithelial ovarian cancer patients before and after a programmatic change in surgical approach from standard surgery towards ultra-radical surgery. Methods: 247 patients with FIGO stage IIIB-IV ovarian, tubal, and primary peritoneal carcinoma were operated during 2013–2019 either by primary or interval cytoreduction in Tampere University Hospital, Finland. Group 1 (n = 122) patients were operated during 2013 and February 2016. Group 2 patients (n = 125) were operated between March 2016 and March 2019, when a systematic change in surgical approach towards more extensive surgery was implemented. Results: The complete resection (R0) rate increased significantly from 17.2% (21/122) to 52.0% (65/125) within the study period (p < 0.001). The median progression-free survival (PFS) was 15.6 months vs 19.3 months (p = 0.037), and the median overall survival (OS) was 33.5 months vs 54.5 months in Groups 1 and 2, respectively (p = 0.028). Median OS for stage III patients in Group 1 was 36.1 months (95% CI 27.4–44.8) but could not be reached in Group 2 (p = 0.009). In Stage IV patients, OS was 32.0 months (16.4–47.7) and 39.3 months (24.8–53.8) in Group 1 and 2, respectively (p = 0.691). Multivariable Cox regression analysis revealed that OS was independently affected by the amount of residual tumor and complication grade. Conclusions: The change of surgical approach towards maximal surgical effort improved both progression-free and overall survival. The survival benefit was unquestionable for stage III patients but did not reach statistical significance in stage IV patients.
AB - Objective: To compare survival rates of surgically treated advanced epithelial ovarian cancer patients before and after a programmatic change in surgical approach from standard surgery towards ultra-radical surgery. Methods: 247 patients with FIGO stage IIIB-IV ovarian, tubal, and primary peritoneal carcinoma were operated during 2013–2019 either by primary or interval cytoreduction in Tampere University Hospital, Finland. Group 1 (n = 122) patients were operated during 2013 and February 2016. Group 2 patients (n = 125) were operated between March 2016 and March 2019, when a systematic change in surgical approach towards more extensive surgery was implemented. Results: The complete resection (R0) rate increased significantly from 17.2% (21/122) to 52.0% (65/125) within the study period (p < 0.001). The median progression-free survival (PFS) was 15.6 months vs 19.3 months (p = 0.037), and the median overall survival (OS) was 33.5 months vs 54.5 months in Groups 1 and 2, respectively (p = 0.028). Median OS for stage III patients in Group 1 was 36.1 months (95% CI 27.4–44.8) but could not be reached in Group 2 (p = 0.009). In Stage IV patients, OS was 32.0 months (16.4–47.7) and 39.3 months (24.8–53.8) in Group 1 and 2, respectively (p = 0.691). Multivariable Cox regression analysis revealed that OS was independently affected by the amount of residual tumor and complication grade. Conclusions: The change of surgical approach towards maximal surgical effort improved both progression-free and overall survival. The survival benefit was unquestionable for stage III patients but did not reach statistical significance in stage IV patients.
KW - Ovarian cancer
KW - Overall survival
KW - Progression-free survival
KW - Surgery
KW - Ultraradical surgery
U2 - 10.1016/j.ygyno.2022.03.023
DO - 10.1016/j.ygyno.2022.03.023
M3 - Article
AN - SCOPUS:85127619898
SN - 0090-8258
VL - 165
SP - 478
EP - 485
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 3
ER -
