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Peroperative extent of peritoneal metastases affects the surgical outcome and survival in advanced ovarian cancer

  • Author Footnotes
    1 Contributed equally to this manuscript.
    R.M. van Stein
    Footnotes
    1 Contributed equally to this manuscript.
    Affiliations
    Department of Gynaecologic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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  • Author Footnotes
    1 Contributed equally to this manuscript.
    M.P. Engbersen
    Footnotes
    1 Contributed equally to this manuscript.
    Affiliations
    Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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  • T. Stolk
    Affiliations
    Department of Gynaecologic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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  • M. Lopez-Yurda
    Affiliations
    Department of Biometrics, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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  • M.J. Lahaye
    Affiliations
    Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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  • R.G.H. Beets-Tan
    Affiliations
    Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands

    GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
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  • C.A.R. Lok
    Affiliations
    Department of Gynaecologic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands

    Center for Gynaecologic Oncology Amsterdam, Amsterdam, the Netherlands
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  • G.S. Sonke
    Affiliations
    Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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  • W.J. Van Driel
    Correspondence
    Corresponding author at: Department of Gynaecologic Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Postbus 90203, 1006 BE Amsterdam, the Netherlands.
    Affiliations
    Department of Gynaecologic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands

    Center for Gynaecologic Oncology Amsterdam, Amsterdam, the Netherlands
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  • Author Footnotes
    1 Contributed equally to this manuscript.
Published:September 07, 2022DOI:https://doi.org/10.1016/j.ygyno.2022.08.022

      Highlights

      • 7 Region Count (7RC) is a concise assessment tool to systematically quantify the extent of peritoneal metastases.
      • Extent of peritoneal metastases, as expressed by the 7RC, is an independent predictor for completeness of interval CRS.
      • The 7RC has independent prognostic value for progression-free and overall survival in addition to completeness of CRS.

      Abstract

      Objective

      Determining whether cytoreductive surgery (CRS) is feasible in patients with advanced ovarian cancer and whether extensive surgery is justified is challenging. Accurate patient selection for CRS based on pre- and peroperative parameters will be valuable. The aim of this study is to assess the association between the extent of peritoneal metastases as determined during surgery and completeness of interval CRS and survival.

      Methods

      This single-center observational cohort study included consecutive patients with newly diagnosed stage III-IV epithelial ovarian cancer who received neoadjuvant chemotherapy and underwent interval CRS. The 7 Region Count (7RC) was recorded during surgical exploration to systematically quantify the extent of peritoneal metastases. Logistic regression analysis was performed to predict surgical outcomes, and Cox regression analysis was done for survival outcomes.

      Results

      A total of 316 patients were included for analyses. The median 7RC was 4 (interquartile range: 2–6). Complete CRS was performed in 58%, optimal CRS in 30%, and incomplete CRS in 12% of patients. A higher 7RC was independently associated with lower odds of complete or optimal CRS in multivariable analysis (odds ratio [OR] = 0.45, 95% confidence interval [CI]: 0.33–0.63, p < 0.001). Similarly, a higher 7RC was independently associated with worse progression-free survival (hazard ratio [HR] = 1.17, 95% CI 1.08–1.26, p < 0.001) and overall survival (HR = 1.14, 95% CI 1.04–1.25, p = 0.007).

      Conclusion

      The extent of peritoneal metastases, as expressed by the 7RC during surgery, is an independent predictor for completeness of CRS and has independent prognostic value for progression-free survival and overall survival in addition to completeness of CRS.

      Keywords

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