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International Journal of Surgical Oncology
Volume 2010 (2010), Article ID 214919, 8 pages
http://dx.doi.org/10.1155/2010/214919
Clinical Study

Outcome in Advanced Ovarian Cancer following an Appropriate and Comprehensive Effort at Upfront Cytoreduction: A Twenty-Year Experience in a Single Cancer Institute

1Department of Surgery, Institut Curie, 25 rue d’Ulm, 75005 Paris, France
2Department of Medical Oncology, Institut Curie, 25 rue d’Ulm, 75005 Paris, France
3Department of Biostatistics, Institut Curie, 25 rue d’Ulm, 75005 Paris, France
4Department of Pathology, Institut Curie, 25 rue d’Ulm, 75005 Paris, France
5Department of Translational Research, Institut Curie, 25 rue d’Ulm, 75005 Paris, France
6Department of Radiotherapy, Institut Curie, 25 rue d’Ulm, 75005 Paris, France
7Department of Radiology, Institut Curie, 25 rue d’Ulm, 75005 Paris, France

Received 1 September 2009; Revised 6 May 2010; Accepted 11 June 2010

Academic Editor: Sanjeev Misra

Copyright © 2010 Anne Marszalek et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives. The purpose of this retrospective evaluation of advanced-stage ovarian cancer patients was to compare outcome with published findings from other centers and to discuss future options for the management of advanced ovarian carcinoma patients. Methods. A retrospective series of 340 patients with a mean age of 58 years (range: 17–88) treated for FIGO stage III and IV ovarian cancer between January 1985 and January 2005 was reviewed. All patients had primary cytoreductive surgery, without extensive bowel, peritoneal, or systematic lymph node resection, thereby allowing initiation of chemotherapy without delay. Chemotherapy consisted of cisplatin-based chemotherapy in combination with alkylating agents before 2000, whereas carboplatin and paclitaxel regimes were generally used after 1999-2000. Overall survival and disease-free survival were analyzed by the Kaplan-Meier method and the log-rank test. Results. With a mean followup of 101 months (range: 5 to 203), 280 events (recurrence or death) were observed and 245 patients (72%) had died. The mortality and morbidity related to surgery were low. The main prognostic factor for overall survival was postoperative residual disease ( ), while the main prognostic factor for disease-free survival was histological tumor type ( ). Multivariate analysis identified three significant risk factors: optimal surgery ( for suboptimal surgery), menopausal status ( for postmenopausal women), and presence of a taxane in the chemotherapy combination ( ). Conclusion. These results confirm that optimal surgery defined by an appropriate and comprehensive effort at upfront cytoreduction limits morbidity related to the surgical procedure and allows initiation of chemotherapy without any negative impact on survival. The impact of neoadjuvant chemotherapy to improve resectability while lowering the morbidity of the surgical procedure is discussed.