The Use of “Optimal Cytoreduction” Nomenclature in Ovarian Cancer Literature: Can We Move Toward a More Optimal Classification System?

2016 ◽  
Vol 26 (8) ◽  
pp. 1421-1427 ◽  
Author(s):  
Ana Milena Angarita ◽  
Rebecca Stone ◽  
Sarah M. Temkin ◽  
Kimberly Levinson ◽  
Amanda N. Fader ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Confidence Interval ◽  
Classification System ◽  
English Language ◽  
Residual Disease ◽  
Optimal Cytoreduction ◽  
Author Study ◽  
Patient Groups ◽  
Study Type ◽  
Over Time

ObjectivesThe objective of this study is to explore how cytoreductive surgical outcomes such as residual disease (RD) and use of the term “optimal cytoreduction” (OCR) have changed over time in the ovarian cancer literature.MethodsWe identified all English-language publications referring to ovarian cancer cytoreduction for a 12-year period. Publications were evaluated for how the diameter of RD was categorized and whether OCR was defined. In addition, the use of RD and OCR terminology trends over time and associations between terminology and the region of corresponding author, study type, and journal impact factor were explored.ResultsOf the 772 publications meeting inclusion criteria, the RD stratification points used to demarcate patient groups were as follows: 0 mm (45%), 5 mm (3.6%), 10 mm (65%), and 20 mm (24%). The use of 0-mm RD (odds ratio [OR], 1.1; 95% confidence interval, 1.05–1.15) and 10-mm RD (OR, 1.1; 95% confidence interval, 1.09–1.20) to delineate patient outcomes increased over time. The use of OCR terminology did not change over time but was more commonly used in clinical studies as well as those from North America. Many studies (70%) defined OCR as less than or equal to 10-mm RD, whereas 30% defined OCR differently or not at all.ConclusionsOptimal cytoreduction terminology remains ambiguous and inconsistently used in the ovarian cancer surgical literature. On the basis of this literature review, we propose a novel classification system to categorize RD without reference to OCR while accurately and succinctly identifying meaningful clinical subgroups and minimizing bias.

The rate and role of diaphragmatic peritonectomy in optimal cytoreduction in patients with advanced stage ovarian cancer: a prospective study of 100 patients

2014 ◽  
Vol 21 (1) ◽  
pp. 1-7
Author(s):  
Tomas Lūža ◽  
Agnė Ožalinskaitė ◽  
Vilius Rudaitis
Keyword(s):  
Ovarian Cancer ◽  
Confidence Interval ◽  
Cytoreductive Surgery ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Optimal Cytoreduction ◽  
Entire Cohort ◽  
Kaplan Meier ◽  
Upper Abdominal ◽  
A Prospective Study

Background. Diaphragmatic peritoneal metastasis by advanced epi­thelial ovarian cancer is a very common holdback precluding optimal cytoreduction. The aim of this study was to determine the rate of dia­phragmatic peritonectomy during optimal cytoreductive surgery and its role in postoperative morbidity and survival in patients with advanced ovarian cancer. Materials and methods. 100 consecutive patients with advanced epithelial ovarian cancer underwent cytoreductive surgery and were followed up prospectively (January 2009 – March 2014). Characteristics of surgery, rate of diaphragmatic peritonectomy and post operative complications were assessed. The Kaplan-Meier method was used for survival analysis. Results. The median age of the entire cohort at the time of primary cytoreduction was 58.5 years (23–83). Optimal cytoreduction was achieved in 73 cases out of 100 patients. From 73 patients in 30 cases (41.1%) upper abdominal procedures, specifically diaphragmatic peritonectomy, was performed to achieve the main goal of cytoreduction  –  no visible or palbable disease at the end of cytoreduction. Non-optimal cytoreduction was achieved in 27 cases. According to the Clavien-Dindo complication grading system grade I and grade II complications occurred more often in patients that underwent diaphragmatic surgery. The median overall survival from the time of diagnosis to the last follow-up or death was 28 months (range 0–63 months). The factors associated with the longest survival after primary cytoreductive surgery were the disease free interval from the primary cytoreduction of more than 19 months (n = 51) versus less than 19 months (n = 49) (95% confidence interval, 51.7–59.5; P = 0.013) and no visible or palpable residual disease at the end of cytoreduction (n = 73) versus visible or palpable residual di­sease (n = 27) (95% confidence interval, 52.7–61.2; P = 0.03). Conclusions. Based on our prospective analysis of advanced ovarian cancer patients, diaphragmatic peritonectomy is feasible and safe, ensures better rates of optimal cytoreduction and should not be an obstacle towards better survival.

scholarly journals The Effect of Nutrition Intervention With Oral Nutritional Supplements on Ovarian Cancer Patients Undergoing Chemotherapy

2021 ◽  
Vol 8 ◽  
Author(s):  
Nan Qin ◽  
Guichun Jiang ◽  
Xu Zhang ◽  
Di Sun ◽  
Meishuo Liu
Keyword(s):  
Ovarian Cancer ◽  
Confidence Interval ◽  
Cancer Patients ◽  
Nutrition Education ◽  
Nutritional Risk ◽  
Secondary Outcome ◽  
Control Group ◽  
Oral Nutritional Supplements ◽  
Over Time

Background: Ovarian cancer is the third most common gynecological malignancy in the world and it is under a higher incidence of malnutrition. Chemotherapy is currently a common treatment for ovarian cancer, but the resulting side effects can exacerbate malnutrition. Our aim was to investigate the beneficial effects of oral nutrition supplements (ONS) on ovarian cancer patients undergoing chemotherapy.Methods: Single-blinded randomized controlled trial. Patients with ovarian cancer receiving chemotherapy were randomly assigned either to the ONS or non-ONS groups via a simple randomization. The ONS group was given 250 mL ONS each time (1.06 kcal, 0.0356 g of protein per mL), three times a day, and nutrition education. Control group received nutrition education alone. The primary outcome was the nutritional risk of the patients as assessed by the Patient-Generated Subjective Global Assessment (PG-SGA). The secondary outcome was the results of the participants' biochemical tests at each measurement time point. Data were collected (T0) at baseline, (T1) post intervention at 3 weeks, (T2) 9-week follow-up, (T3) 15-week follow-up. Generalized estimating equation models were used to compare the changes in outcomes over time between groups.Results: 60 participants (30 ONS, 30 controls) completed the trial, and data was analyzed. For baseline comparisons, no significant differences were found between the two groups. A progressive trend toward amelioration in PG-SGA scores over time was found within the ONS group, with scores decreasing from 9.27 ± 1.68 at baseline (T0) to 5.87 ± 2.06 after the intervention (T3). Furthermore, ONS group achieved a significantly greater reduction in PG-SGA score at the T1 (p = 0.03, confidence interval −2.23 to −0.11), T2 (p = 0.001, confidence interval −2.86 to −0.74) and T3 (p < 0.001, confidence interval −3.81 to −1.53), than the control group. In terms of biochemical test results, patients in the ONS group had better leukocytes, lymphocytes, Hemoglobin, Albumin and Total Protein than the control group at different time points, with statistical differences between the two groups (p < 0.05).Conclusions: The present study demonstrated that ONS can significantly reduce the nutritional risk of patients undergoing chemotherapy for ovarian cancer. In addition, we also found that nutritional education seems to have a positive effect on reducing the nutritional risk of patients especially at the beginning of chemotherapy.

scholarly journals The clinical and pathological characteristics and survival of patients with advanced ovarian cancer

2021 ◽  
Vol 52 (3) ◽  
pp. 205-210
Author(s):  
Miroslav Popović ◽  
Tanja Milić-Radić ◽  
Arnela Cerić-Banićević
Keyword(s):  
Ovarian Cancer ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Figo Stage ◽  
Ovarian Tumour ◽  
Ca 125 ◽  
Optimal Cytoreduction ◽  
Chi Square ◽  
Pathological Characteristics ◽  
Significant Difference

Introduction: Ovarian cancer has the highest mortality rate of all gynaecologic malignancies. The aim of this study was the evaluation of the clinical pathological characteristics and survival analysis of primarily operated patients with advanced stages of malignant epithelial ovarian tumour. Methods: The research was conducted as a cohort study with 59 patients with FIGO stage III and IV, which were primarily operated between 1 January 2008 and 31 December 2010 (three years). Age, comorbidities, BMI, presence of ascites, the level of the marker CA-125, histopathology and FIGO stage were analysed. The survival rate was estimated at the level of 1, 3 and 5 years. Results: The median age was 53 years (range 29-86). The most common histopathological type was serous (66.1 %) and the most common FIGO stage was 3a (49.2 %). Optimal cytoreduction was performed in 35.5 % of patients, 84.7 % of patients survived for one year, 44.1 % three years and 37.3 % for five years. The median survival was 26.25 months (range 0-91). Chi-square test showed significant difference between the number of months of survival and: the value of CA125 (t = 2.004, p = 0.050), cytoreduction (p < 0.001) and FIGO stage (p < 0.01). Conclusion: According to the results of this study, optimal cytoreduction and FIGO stage significantly influence survival (p < 0.001). Optimal cytoreduction (< 2 cm of residual disease) had the highest prognostic value for survival. A total five-year survival in this study was 37.3 %.

Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy

2012 ◽  
Vol 125 (2) ◽  
pp. 362-366 ◽  
Author(s):  
Noah Rodriguez ◽  
J. Alejandro Rauh-Hain ◽  
Melina Shoni ◽  
Ross S. Berkowitz ◽  
Michael G. Muto ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Residual Disease ◽  
Ca 125 ◽  
Advanced Stage ◽  
Optimal Cytoreduction

scholarly journals Clinicopathologic features of epithelial ovarian cancer

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Fatima Asif ◽  
Ambreen Sattar ◽  
Shaharyar .
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Clinical Oncology ◽  
Residual Disease ◽  
Signs And Symptoms ◽  
Staging System ◽  
Optimal Cytoreduction ◽  
Clinicopathologic Features ◽  
Late Stages ◽  
Record Section

Objectives: This retrospective study was conducted at the Clinical Oncology Department of Mayo Hospital with the objectives to find out the frequency of different clinicopathologic features and to see the pattern of treatment and its outcome. Patients and methods: From 2000 to 2004, 375 patients were seen at the Department of Clinical Oncology, Mayo hospital, Lahore. A proforma was designed to document the age, parity, histopathology, stage, grade, clinical features, and family history. The information was obtained from the medical record section. Stage was assigned according to FIGO staging system. All patients with histopathologically proven epithelial ovarian cancer were included. Results: Epithelial ovarian cancer constituted 8.4 % of all female cancers. The median age at presentation was 51 years (range, 21-75 years). All patients were symptomatic before the diagnosis, with ascites being the most common single manifestation (38.4 %) and in patients with multiple signs and symptoms abdominal sym ptoms were most commonly seen (71.5 %). Median pre operative CA125 level was 218 U/ml. ).Optimal cytoreduction was seen in 36.5 % only, and 63.5% patients presented after sub-optimal cytoreduction. Majority of the patients (82.7%) presented in late stages (III & IV) and only 17.3 % in early stages (I&II). Most common histopathologic type of invasive cancer was serous cystadenocarcinoma , seen in 247(72.4%) patients. Endometrioid tumors were seen in very few (3.8 % ).High grade tumors were the most common. Most women were multiparous and only 16.5% were nulliparous. Post operative treatment primarily included cisplatin based combination chemotherapy. One hundred and twenty seven patients were re treated for recurrent or residual disease and 68 were referred for secondary cytoreduction and were given second line therapy subsequently. Conclusion: Epithelial ovarian cancer is not a silent disease, most patients are symptomatic and present in an advanced stage. In majority of the patients optimal cytoreduction is not achieved. Cystadenocarcinoma is the predominant histology and the endometrioid variety is seen only in few.

Clinical Outcome After Completion Surgery in Patients With Ovarian Cancer: The Charite Experience

2018 ◽  
Vol 28 (8) ◽  
pp. 1491-1497 ◽  
Author(s):  
Aygun Babayeva ◽  
Elena Ioana Braicu ◽  
Jacek P. Grabowski ◽  
Khayal Gasimli ◽  
Rolf Richter ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Confidence Interval ◽  
Epithelial Ovarian Cancer ◽  
Residual Disease ◽  
Related Data ◽  
Primary Debulking Surgery ◽  
Gynecology And Obstetrics ◽  
Advanced Stages ◽  
Completion Surgery ◽  
Prospective Database

ObjectiveThe aim of this study was to estimate surgical outcome and survival benefit after completion surgery.MethodsWe evaluated 164 patients with epithelial ovarian cancer who underwent incomplete primary cytoreductive surgery or rather received only staging procedures from January 2000 to December 2014 in outside institutions. Patient-related data were registered in prospective database of Tumor Bank Ovarian Cancer. The outcome analyses were performed for early and advanced stages of ovarian cancer separately.ResultsThe majority of patients were at the time of completion surgery in advanced stages of disease. From overall 111 advanced epithelial ovarian cancer patients, 74 (66.6%) could be operated macroscopically tumor free, minimal residual disease 1 cm or less was achieved in 15.3% of the cases. Mean overall survival for patients without versus those with any tumor residual was 70 months (95% confidence interval, 61.3–81.5) versus 24.7 months (95% confidence interval, 7.1–42.4; P ⩽ 0.0001). After applying completion surgery, 47 (28.6%) and 12 (6.7%) patients were upstaged in FIGO (International Federation of Gynecology and Obstetrics) IIIC and IV stages, respectively. Upstaging resulted in therapy changes in 10 patients (19%) with assumed FIGO IA stages. Major operative complications were registered in 28.8% of advanced cases, and 30-day mortality reached 1.8%.ConclusionsRecent research has shown that the most profound impact on survivorship occurs when women get proper care from surgeons trained in the latest techniques for treating ovarian cancer. Completion surgery maintained that even after initial incomplete cytoreduction outside of the high specialized units, after applying appropriate surgery techniques macroscopically, disease-free situation is achievable and outcomes are comparable with the results of primary debulking surgery.

Stage IV ovarian cancer: a retrospective study on patient's management and outcome in a single institution

2005 ◽  
Vol 15 (4) ◽  
pp. 606-611
Author(s):  
Y. Brunisholz ◽  
J. Miller ◽  
A. Proietto
Keyword(s):  
Ovarian Cancer ◽  
Residual Disease ◽  
Disease Free Survival ◽  
Stage Iv ◽  
Distant Metastases ◽  
Optimal Cytoreduction ◽  
Pleural Effusions ◽  
Primary Surgery ◽  
Significant Difference ◽  
Stage Iv Disease

The management of stage IV epithelial ovarian carcinoma remains controversial. The aim of this study was to evaluate and compare our results to other published series. A retrospective database and casenote review was performed on all patients diagnosed with stage IV disease over a ten-year period (1992–2002). Survival analysis was performed using the Kaplan–Meier and Mantel–Haenszel methods. The study group comprised 23 women. Nine had positive pleural effusions (39.1%), and 14 had other sites of metastases (60.9%). Nine patients underwent interval debulking (39.1%), and 14 were operated on primarily (60.9%). We had six postoperative complications (26.1%) but no perioperative deaths. Optimal cytoreduction (inferior or equal to 2 cm residual disease) was obtained in 18 patients (78.3%). The overall median survival was 22.6 months. There was no statistically significant difference in overall or disease-free survival between primary surgery and interval debulking. Patients with positive pleural effusions had significantly reduced survival compared to those with distant metastases in other sites. Interestingly, there was no difference in survival between optimally and suboptimally cytoreduced patients. Debulking surgery can be performed in patients with stage IV ovarian cancer, with an acceptable level of morbidity. Optimal cytoreduction is achievable in the majority of these patients. Interval debulking should be considered in selected patients

Short-term survival of ovarian cancer patients waiting more than six weeks after surgery before chemotherapy is given

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 5070-5070
Author(s):  
T. Paulsen ◽  
J. Kærn ◽  
K. Kjærheim ◽  
T. Haldorsen ◽  
C. Tropé
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Residual Disease ◽  
Short Term ◽  
Term Survival ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
Patient Groups ◽  
The Impact ◽  
Short Term Survival

5070 Background: To investigate the impact on short-term survival of time between surgery and start of first chemotherapy cycle in patients with advanced ovarian cancer. Methods: This prospective, population-based study comprised 371 patients with epithelial ovarian, tubal or peritoneal cancer diagnosed in 2002–2003. All patients underwent primary surgery, followed at different intervals by chemotherapy. The data were derived from notifications to the Norwegian Cancer Registry and included medical, surgical and histopathological records. Kaplan-Meier plots were used to show differences in survival, and Cox regression analysis was used to show the effect of prognostic factors on survival, expressed as hazard ratios (HRs). Results: No difference in survival between patient groups was seen when time between surgery and start of chemotherapy was divided into quartiles. The group of patients with interval between surgery and chemotherapy less than six weeks had inferior survival if they had residual disease after surgery. Adjusted HR = 2.36 (95% CI, 1.22–4.57). However, in the patient groups with interval more than six weeks, there was no significant difference in survival between patients without and with residual disease. Adjusted HR = 1.35 (0.51–3.56) versus HR = 1.64 (0.76–3.57). Conclusions: The interval between surgery and start of chemotherapy had no major impact on short-term survival after ovarian cancer. Patients might be included in chemotherapy trials when interval between surgery and start of chemotherapy is more than six weeks. [Table: see text] No significant financial relationships to disclose.

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