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dc.contributor.advisorMancuso, Carol
dc.contributor.authorSuidan, Rudy
dc.date.accessioned2019-03-26T15:29:13Z
dc.date.available2019-03-27T06:01:58Z
dc.date.issued2015
dc.identifier.urihttps://hdl.handle.net/1813/64639
dc.description.abstractINTRODUCTION: Predicting suboptimal primary debulking and perioperative complications will lead to improved outcomes for patients with advanced ovarian, fallopian tube, and peritoneal cancer. MANUSCRIPT I: A multicenter prospective trial evaluating the ability of preoperative computed tomography (CT) scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer OBJECTIVE: To assess the ability of preoperative CT scan and CA-125 to predict suboptimal (>1cm residual disease) primary cytoreduction in advanced ovarian, fallopian tube, and peritoneal cancer. METHODS: This was a prospective multicenter trial of patients who underwent primary cytoreduction for stage III-IV ovarian, fallopian tube, and peritoneal cancer. A CT scan of the abdomen/pelvis and serum CA-125 were obtained within 35 and 14 days before surgery, respectively. Four clinical and 20 radiologic criteria were assessed. RESULTS: From 7/2001-12/2012, 350 patients met eligibility criteria. The optimal debulking rate was 75%. On multivariate analysis, three clinical and six radiologic criteria were significantly associated with suboptimal debulking: age ?60 years (p=0.01); CA-125 ?500 U/mL (p<0.001); ASA 3-4 (p<0.001); suprarenal retroperitoneal lymph nodes >1cm (p<0.001); diffuse small bowel adhesions/thickening (p<0.001); and lesions >1cm in the small bowel mesentery (p=0.03), root of the superior mesenteric artery (p=0.003), perisplenic area (p<0.001), and lesser sac (p<0.001). A `predictive value score' was assigned for each criterion, and the suboptimal debulking rates of patients who had a total score of 0, 1-2, 3-4, 5-6, 7-8, and ?9 were 5%, 10%, 17%, 34%, 52%, and 74%, respectively. A prognostic model combining these nine factors had a predictive accuracy of 0.758. CONCLUSIONS: We identified nine criteria associated with suboptimal debulking, and developed a model that was predictive of suboptimal cytoreduction. These results may be helpful in pretreatment patient assessment. MANUSCRIPT II: Predictive value of the age-adjusted charlson comorbidity index on perioperative complications and survival in patients undergoing primary debulking surgery for advanced epithelial ovarian cancer OBJECTIVE: To assess the ability of the age-adjusted Charlson comorbidity index (ACCI) to predict perioperative complications and survival in patients undergoing primary debulking surgery for advanced epithelial ovarian cancer (EOC). METHODS: Data were analyzed for all patients with stage IIIB-IV EOC who underwent primary cytoreduction from 1/2001-1/2010 at our institution. Patients were divided into 3 groups based on an ACCI of 0-1, 2-3, and ?4. Clinical and survival outcomes were assessed and compared. RESULTS: We identified 567 patients; 199 (35%) had an ACCI of 0-1, 271 (48%) had an ACCI of 2-3, and 97 (17%) had an ACCI of ?4. The ACCI was significantly associated with the rate of complete gross resection (0-1=44%, 2-3=32%, and ?4=32%; p=0.02), but was not associated with the rate of minor (47% vs 47% vs 43%, p=0.84) or major (18% vs 19% vs 16%, p=0.8) complications. The ACCI was also significantly associated with progression-free (PFS) and overall survival (OS). Median PFS for patients with an ACCI of 0-1, 2-3, and ?4 was 20.3m, 16m, and 15.4m, respectively (p=0.02). Median OS for patients with an ACCI of 0-1, 2-3, and ?4 was 65.3m, 49.9m, and 42.3m, respectively (p<0.001). On multivariate analysis, the ACCI remained a significant prognostic factor for both PFS (p=0.02) and OS (p<0.001). CONCLUSIONS: The ACCI was not associated with perioperative complications in patients undergoing primary cytoreduction for advanced EOC, but was a significant predictor of PFS and OS. Prospective clinical trials in ovarian cancer should consider stratifying for an age-comorbidity covariate. OVERALL CONCLUSIONS: Nine criteria associated with suboptimal cytoreduction were identified, and a model that was predictive of suboptimal debulking was developed. The ACCI was not associated with perioperative complications, but was a significant prognostic factor for survival outcomes.
dc.language.isoen_US
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectage-adjusted charlson comorbidity index
dc.subjectCT scan
dc.subjectovarian cancer
dc.subjectperioperative complications
dc.subjectsuboptimal cytoreduction
dc.subjectsurvival
dc.titlePredicting Outcomes At Primary Debulking Surgery For Advanced Epithelial Ovarian, Fallopian Tube, And Peritoneal Cancer
dc.typedissertation or thesis
thesis.degree.disciplineClinical Epidemiology & Health Services Research
thesis.degree.grantorWeill Cornell Graduate School of Medical Sciences
thesis.degree.levelMaster of Science


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