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Patients with stage IV epithelial ovarian cancer: understanding the determinants of survival

Authors
  • Dabi, Yohann1
  • Huchon, Cyrille2
  • Ouldamer, Lobna3
  • Bendifallah, Sofiane4
  • Collinet, Pierre5
  • Bricou, Alexandre6
  • Daraï, Emile4
  • Ballester, Marcos4
  • Lavoue, Vincent7
  • Haddad, Bassam1
  • Touboul, Cyril1, 4, 8
  • 1 Centre Hospitalier Intercommunal, Faculté de médecine de Créteil UPEC-Paris XII, Créteil, France , Créteil (France)
  • 2 Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy – Saint Germain – en – Laye, Poissy, 78103, France , Poissy (France)
  • 3 Centre hospitalier régional universitaire de Tours, hôpital Bretonneau, Tours, France , Tours (France)
  • 4 Assistance Publique, Hôpitaux de Paris (AP-HP) des, University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France , Paris (France)
  • 5 Centre Hospitalier Régional Universitaire, Lille, France , Lille (France)
  • 6 Assistance Publique, Hôpitaux de Paris (AP-HP) des, Paris, France , Paris (France)
  • 7 CHU de Rennes, Université de Rennes 1, Rennes, France , Rennes (France)
  • 8 Hôpital Intercommunal de Créteil, 40 Avenue de Verdun, Créteil, 94000, France , Créteil (France)
Type
Published Article
Journal
Journal of Translational Medicine
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Mar 23, 2020
Volume
18
Issue
1
Identifiers
DOI: 10.1186/s12967-020-02295-y
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundThe most appropriate management for patients with stage IV ovarian cancer remains unclear. Our objective was to understand the main determinants associated with survival and to discuss best surgical management.MethodsData of 1038 patients with confirmed ovarian cancer treated between 1996 and 2016 were extracted from maintained databases of 7 French referral gynecologic oncology institutions. Patients with stage IV diseases were selected for further analysis. The Kaplan–Meier method was used to estimate the survival distribution. A Cox proportional hazards model including all the parameters statistically significant in univariable analysis, was used to account for the influence of multiple variables.ResultsTwo hundred and eight patients met our inclusion criteria: 65 (31.3%) never underwent debulking surgery, 52 (25%) underwent primary debulking surgery (PDS) and 91 (43.8%) neoadjuvant chemotherapy and interval debulking surgery (NACT-IDS). Patients not operated had a significantly worse overall survival than patients that underwent PDS or NACT–IDS (p < 0.001). In multivariable analysis, three factors were independent predictors of survival: upfront surgery (HR 0.32 95% CI 0.14–0.71, p = 0.005), postoperative residual disease = 0 (HR 0.37 95% CI 0.18–0.75, p = 0.006) and association of Carboplatin and Paclitaxel regimen (HR 0.45 95% CI 0.25–0.80, p = 0.007).ConclusionsPresence of distant metastases should not refrain surgeons from performing radical procedures, whenever the patient is able to tolerate. Maximal surgical efforts should be done to minimize residual disease as it is the main determinant of survival.

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