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A novel algorithm for the treatment strategy for advanced epithelial ovarian cancer: consecutive imaging, frailty assessment, and diagnostic laparoscopy
- Source :
- BMC Cancer, BMC Cancer, Vol 17, Iss 1, Pp 1-7 (2017)
- Publication Year :
- 2017
- Publisher :
- BioMed Central, 2017.
-
Abstract
- Background This study aimed to evaluate the perioperative outcomes and prognostic impact of the consecutive steps of imaging, frailty assessment, and diagnostic laparoscopy (DLS) in patients with advanced epithelial ovarian cancer (EOC). Methods Patients diagnosed with EOC during 2012–2015 were analyzed retrospectively. Surgical and survival outcomes were compared between three treatment groups: patients without high tumor dissemination (HTD) who underwent primary debulking surgery (PDS group); patients with HTD who underwent DLS (DLS group); and patients with HTD diagnosed by cytological confirmation of malignancy followed by neoadjuvant chemotherapy (NACT group). Results Of 181 patients, 85, 38, and 58 underwent PDS, DLS, and NACT, respectively. Among the 38 consecutive patients who initially underwent DLS, 6 were considered suitable for PDS; the remaining 32 were eligible for NACT followed by interval debulking surgery. The median operative times of debulking surgery in the PDS, DLS, and NACT groups were 365 min (interquartile range [IQR]: 216.5–476.5 min), 266.2 min (IQR: 160.3–193.5 min), and 339.0 min (IQR: 205–425 min; P = 0.042), respectively, with respective median estimated blood loss volumes of 962.2 mL (IQR: 300–1037.5 mL), 267.1 mL (IQR: 150–450 mL), and 861.7 mL (IQR: 150–1200 mL; P = 0.023). The DLS group had significantly reduced transfusion requirements and intensive care unit admission rates (P = 0.006). The Kaplan–Meier survival analysis indicated significantly poor PFS in the NACT group. However, there was no significant difference in OS among the three groups. Conclusions The consecutive steps of imaging, frailty assessment, and DLS might facilitate rapid assessments of peritoneal disease extent and resectability; this novel algorithm might also be used to individualize treatment.
- Subjects :
- Adult
Cancer Research
medicine.medical_specialty
Kaplan-Meier Estimate
Carcinoma, Ovarian Epithelial
Malignancy
lcsh:RC254-282
Disease-Free Survival
law.invention
03 medical and health sciences
0302 clinical medicine
Interquartile range
law
Surgical oncology
Debulking surgical procedures
Genetics
Medicine
Humans
Neoplasms, Glandular and Epithelial
Laparoscopy
Survival analysis
Aged
Neoplasm Staging
Ovarian Neoplasms
030219 obstetrics & reproductive medicine
medicine.diagnostic_test
Frailty
business.industry
Perioperative
Cytoreduction Surgical Procedures
Epithelial ovarian cancer
Middle Aged
medicine.disease
Debulking
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Intensive care unit
Neoadjuvant Therapy
Surgery
Treatment Outcome
Oncology
030220 oncology & carcinogenesis
Female
business
Algorithm
Research Article
Subjects
Details
- Language :
- English
- ISSN :
- 14712407
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- BMC Cancer
- Accession number :
- edsair.doi.dedup.....23332916a3b33bba33e8a3bef91126c9