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Are There Survival Differences Between Women with Equivalent Residual Disease After Interval Cytoreductive Surgery Compared with Primary Cytoreductive Surgery for Advanced Ovarian and Peritoneal Cancer?

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to investigate survival differences between equivalent residual disease [complete gross resection (CGR), minimal residual disease (MRD), suboptimal] at the time of primary debulking surgery (PDS) and interval debulking surgery (IDS).

Methods

The National Cancer Database was used to identify patients from 2010 to 2015 with stage IIIC/IV primary peritoneal or ovarian cancer who had residual disease recorded. Propensity score matching (PSM) was used to correct for differences in characteristics between the PDS and IDS groups.

Results

Of 8683 patients with advanced ovarian cancer, 4493 (52%), 2546 (29%), and 1644 (19%) had CGR, MRD, or suboptimal resection, respectively. From 2010 to 2015, the number of patients undergoing IDS increased 27% (ptrend < 0.001), and there was an 18% increase in CGRs (ptrend = 0.005). The increased use of IDS from 2010 to 2015 was associated with increased CGRs (ptrend = 0.02) and decreased MRD (ptrend = 0.001), but not with decreased suboptimal resections (ptrend = 0.18). IDS, even after PSM, was associated with inferior overall survival [OS; hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.03–1.22, p = 0.008]. A CGR at PDS had prolonged median OS compared with a CGR at IDS (51 vs. 44 months, p < 0.001). Additionally, MRD at PDS had worse median OS compared with a CGR at IDS (41 vs. 44 months, p = 0.03), but improved median OS compared with MRD at IDS (median OS 35 months, p = 0.05).

Conclusion

The use of IDS continues to rise in the US, and is associated with improved surgical outcomes but not necessarily similar oncologic outcomes. There should be continued efforts to improve cytoreductive outcomes in women with advanced ovarian and peritoneal malignancies.

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Acknowledgment

The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

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Authors and Affiliations

  1. Obstetrics and Gynecology, University of North Carolina Hospitals, Women’s Hospital, Chapel Hill, NC, USA

    David Pierce Mysona MD, Victoria Bae-Jump MD, PhD & Paola A. Gehrig MD

  2. Medical College of Georgia, Augusta, GA, USA

    Sharad Ghamande MD, Jin-Xiong She PhD, Lynn Tran PhD, Paul Tran PhD & Bunja J. Rungruang MD

  3. Jinfinti Precision Medicine, Inc., Augusta, GA, USA

    Jin-Xiong She PhD

  4. Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA

    John K. Chan MD

  5. California Pacific and Palo Alto Medical Foundation/Sutter Health Research Institute, San Francisco, CA, USA

    John K. Chan MD

  6. University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA

    Victoria Bae-Jump MD, PhD & Paola A. Gehrig MD

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  1. David Pierce Mysona MD
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Corresponding author

Correspondence to David Pierce Mysona MD.

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Disclosure

David P. Mysona, Sharad Ghamande, Jin-Xiong She, Lynn Tran, Paul Tran, Bunja J. Rungruang, John K. Chan, Victoria Bae-Jump, and Paola A. Gehrig have no conflicts of interest in relation to the submitted work. Outside of the submitted work, Dr Ghamande has received compensation from GlaxoSmithKline for consulting and from Merck as part of their speakers’ bureau. Dr. Chan has received compensation from Acerta, Aravive, Biodesix, Clovis, Janssen/J&J, Oxigen/Mateon, Roche/Genentech, Tesaro, Astra Zeneca, and Eisai.

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Mysona, D.P., Ghamande, S., She, JX. et al. Are There Survival Differences Between Women with Equivalent Residual Disease After Interval Cytoreductive Surgery Compared with Primary Cytoreductive Surgery for Advanced Ovarian and Peritoneal Cancer?. Ann Surg Oncol 28, 3605–3615 (2021). https://doi.org/10.1245/s10434-020-09304-w

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  • DOI: https://doi.org/10.1245/s10434-020-09304-w

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