What is the role of retroperitoneal exploration in optimally debulked stage IIIC epithelial ovarian cancer? An NRG Oncology/Gynecologic Oncology Group ancillary data study

Bunja J. Rungruang; Austin Miller; Thomas C. Krivak; Neil S. Horowitz; Noah Rodriguez; Chad A. Hamilton; Floor J. Backes; Linda F. Carson; Michael Friedlander; David G. Mutch; Michael J. Goodheart; Krishnansu S. Tewari; Robert M. Wenham; Michael A. Bookman; G. Larry Maxwell; Scott D. Richard

doi:10.1002/cncr.30414

What is the role of retroperitoneal exploration in optimally debulked stage IIIC epithelial ovarian cancer? An NRG Oncology/Gynecologic Oncology Group ancillary data study

Bunja J. Rungruang, Austin Miller, Thomas C. Krivak, Neil S. Horowitz, Noah Rodriguez, Chad A. Hamilton, Floor J. Backes, Linda F. Carson, Michael Friedlander, David G. Mutch, Michael J. Goodheart, Krishnansu S. Tewari, Robert M. Wenham, Michael A. Bookman, G. Larry Maxwell, Scott D. Richard

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Abstract

BACKGROUND: The purpose of this study was to determine the effect of retroperitoneal (RP) exploration on progression-free survival (PFS) and overall survival (OS) in epithelial ovarian cancer (EOC) patients with stage IIIC disease who underwent optimal debulking surgery. METHODS: Data were collected from records of the Gynecologic Oncology Group 182 (GOG-182) study of stage IIIC EOC patients cytoreduced to no gross residual disease (R0) or minimal gross residual (<1 cm) disease (MGRD) at primary surgery. Patients with stage IIIC disease by intraperitoneal (IP) tumor were included and divided into 3 groups: 1) > 2 cm IP tumor without lymph node involvement (IP/RP−), 2) > 2 cm IP tumor with lymph node involvement (IP/RP+), and 3) > 2 cm IP tumor with no RP exploration (IP/RP?). The effects of disease distribution and RP exploration on PFS and OS were assessed using Kaplan–Meier and proportional hazards methods. RESULTS: There were 1871 stage IIIC patients in GOG-182 who underwent optimal primary debulking surgery. Of these, 689 (36.8%) underwent RP exploration with removal of lymph nodes from at least 1 para-aortic site, and 1182 (63.2%) did not. There were 269 patients in the IP/RP− group, 420 patients in the IP/RP + group, and 1182 patients in the IP/RP? group. Improved PFS (18.5 vs 16.0 months; P <.0001) and OS (53.3 vs 42.8 months; P <.0001) were associated with RP exploration versus no exploration. Patients with MGRD had improved PFS (16.8 vs 15.1 months, P = 0.0108) and OS (44.9 vs 40.5 months, P = 0.0076) versus no exploration. CONCLUSIONS: RP exploration at the time of primary surgery in patients with optimally debulked stage IIIC EOC is associated with a survival benefit. Cancer 2017;123:985–93.

Original language	English
Pages (from-to)	985-993
Number of pages	9
Journal	Cancer
Volume	123
Issue number	6
DOIs	https://doi.org/10.1002/cncr.30414
State	Published - Mar 15 2017

Keywords

disease burden
lymphadenectomy
ovarian cancer
retroperitoneal exploration
surgical debulking

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10.1002/cncr.30414

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Rungruang, B. J., Miller, A., Krivak, T. C., Horowitz, N. S., Rodriguez, N., Hamilton, C. A., Backes, F. J., Carson, L. F., Friedlander, M., Mutch, D. G., Goodheart, M. J., Tewari, K. S., Wenham, R. M., Bookman, M. A., Maxwell, G. L., & Richard, S. D. (2017). What is the role of retroperitoneal exploration in optimally debulked stage IIIC epithelial ovarian cancer? An NRG Oncology/Gynecologic Oncology Group ancillary data study. Cancer, 123(6), 985-993. https://doi.org/10.1002/cncr.30414

@article{091091b0587d4d05a8779da7a22de6ad,

title = "What is the role of retroperitoneal exploration in optimally debulked stage IIIC epithelial ovarian cancer? An NRG Oncology/Gynecologic Oncology Group ancillary data study",

abstract = "BACKGROUND: The purpose of this study was to determine the effect of retroperitoneal (RP) exploration on progression-free survival (PFS) and overall survival (OS) in epithelial ovarian cancer (EOC) patients with stage IIIC disease who underwent optimal debulking surgery. METHODS: Data were collected from records of the Gynecologic Oncology Group 182 (GOG-182) study of stage IIIC EOC patients cytoreduced to no gross residual disease (R0) or minimal gross residual (<1 cm) disease (MGRD) at primary surgery. Patients with stage IIIC disease by intraperitoneal (IP) tumor were included and divided into 3 groups: 1) > 2 cm IP tumor without lymph node involvement (IP/RP−), 2) > 2 cm IP tumor with lymph node involvement (IP/RP+), and 3) > 2 cm IP tumor with no RP exploration (IP/RP?). The effects of disease distribution and RP exploration on PFS and OS were assessed using Kaplan–Meier and proportional hazards methods. RESULTS: There were 1871 stage IIIC patients in GOG-182 who underwent optimal primary debulking surgery. Of these, 689 (36.8%) underwent RP exploration with removal of lymph nodes from at least 1 para-aortic site, and 1182 (63.2%) did not. There were 269 patients in the IP/RP− group, 420 patients in the IP/RP + group, and 1182 patients in the IP/RP? group. Improved PFS (18.5 vs 16.0 months; P <.0001) and OS (53.3 vs 42.8 months; P <.0001) were associated with RP exploration versus no exploration. Patients with MGRD had improved PFS (16.8 vs 15.1 months, P = 0.0108) and OS (44.9 vs 40.5 months, P = 0.0076) versus no exploration. CONCLUSIONS: RP exploration at the time of primary surgery in patients with optimally debulked stage IIIC EOC is associated with a survival benefit. Cancer 2017;123:985–93.",

keywords = "disease burden, lymphadenectomy, ovarian cancer, retroperitoneal exploration, surgical debulking",

author = "Rungruang, {Bunja J.} and Austin Miller and Krivak, {Thomas C.} and Horowitz, {Neil S.} and Noah Rodriguez and Hamilton, {Chad A.} and Backes, {Floor J.} and Carson, {Linda F.} and Michael Friedlander and Mutch, {David G.} and Goodheart, {Michael J.} and Tewari, {Krishnansu S.} and Wenham, {Robert M.} and Bookman, {Michael A.} and Maxwell, {G. Larry} and Richard, {Scott D.}",

note = "Publisher Copyright: {\textcopyright} 2016 American Cancer Society",

year = "2017",

month = mar,

day = "15",

doi = "10.1002/cncr.30414",

language = "English",

volume = "123",

pages = "985--993",

journal = "Cancer",

issn = "0008-543X",

number = "6",

}

Rungruang, BJ, Miller, A, Krivak, TC, Horowitz, NS, Rodriguez, N, Hamilton, CA, Backes, FJ, Carson, LF, Friedlander, M, Mutch, DG, Goodheart, MJ, Tewari, KS, Wenham, RM, Bookman, MA, Maxwell, GL & Richard, SD 2017, 'What is the role of retroperitoneal exploration in optimally debulked stage IIIC epithelial ovarian cancer? An NRG Oncology/Gynecologic Oncology Group ancillary data study', Cancer, vol. 123, no. 6, pp. 985-993. https://doi.org/10.1002/cncr.30414

TY - JOUR

T1 - What is the role of retroperitoneal exploration in optimally debulked stage IIIC epithelial ovarian cancer? An NRG Oncology/Gynecologic Oncology Group ancillary data study

AU - Rungruang, Bunja J.

AU - Miller, Austin

AU - Krivak, Thomas C.

AU - Horowitz, Neil S.

AU - Rodriguez, Noah

AU - Hamilton, Chad A.

AU - Backes, Floor J.

AU - Carson, Linda F.

AU - Friedlander, Michael

AU - Mutch, David G.

AU - Goodheart, Michael J.

AU - Tewari, Krishnansu S.

AU - Wenham, Robert M.

AU - Bookman, Michael A.

AU - Maxwell, G. Larry

AU - Richard, Scott D.

PY - 2017/3/15

Y1 - 2017/3/15

N2 - BACKGROUND: The purpose of this study was to determine the effect of retroperitoneal (RP) exploration on progression-free survival (PFS) and overall survival (OS) in epithelial ovarian cancer (EOC) patients with stage IIIC disease who underwent optimal debulking surgery. METHODS: Data were collected from records of the Gynecologic Oncology Group 182 (GOG-182) study of stage IIIC EOC patients cytoreduced to no gross residual disease (R0) or minimal gross residual (<1 cm) disease (MGRD) at primary surgery. Patients with stage IIIC disease by intraperitoneal (IP) tumor were included and divided into 3 groups: 1) > 2 cm IP tumor without lymph node involvement (IP/RP−), 2) > 2 cm IP tumor with lymph node involvement (IP/RP+), and 3) > 2 cm IP tumor with no RP exploration (IP/RP?). The effects of disease distribution and RP exploration on PFS and OS were assessed using Kaplan–Meier and proportional hazards methods. RESULTS: There were 1871 stage IIIC patients in GOG-182 who underwent optimal primary debulking surgery. Of these, 689 (36.8%) underwent RP exploration with removal of lymph nodes from at least 1 para-aortic site, and 1182 (63.2%) did not. There were 269 patients in the IP/RP− group, 420 patients in the IP/RP + group, and 1182 patients in the IP/RP? group. Improved PFS (18.5 vs 16.0 months; P <.0001) and OS (53.3 vs 42.8 months; P <.0001) were associated with RP exploration versus no exploration. Patients with MGRD had improved PFS (16.8 vs 15.1 months, P = 0.0108) and OS (44.9 vs 40.5 months, P = 0.0076) versus no exploration. CONCLUSIONS: RP exploration at the time of primary surgery in patients with optimally debulked stage IIIC EOC is associated with a survival benefit. Cancer 2017;123:985–93.

AB - BACKGROUND: The purpose of this study was to determine the effect of retroperitoneal (RP) exploration on progression-free survival (PFS) and overall survival (OS) in epithelial ovarian cancer (EOC) patients with stage IIIC disease who underwent optimal debulking surgery. METHODS: Data were collected from records of the Gynecologic Oncology Group 182 (GOG-182) study of stage IIIC EOC patients cytoreduced to no gross residual disease (R0) or minimal gross residual (<1 cm) disease (MGRD) at primary surgery. Patients with stage IIIC disease by intraperitoneal (IP) tumor were included and divided into 3 groups: 1) > 2 cm IP tumor without lymph node involvement (IP/RP−), 2) > 2 cm IP tumor with lymph node involvement (IP/RP+), and 3) > 2 cm IP tumor with no RP exploration (IP/RP?). The effects of disease distribution and RP exploration on PFS and OS were assessed using Kaplan–Meier and proportional hazards methods. RESULTS: There were 1871 stage IIIC patients in GOG-182 who underwent optimal primary debulking surgery. Of these, 689 (36.8%) underwent RP exploration with removal of lymph nodes from at least 1 para-aortic site, and 1182 (63.2%) did not. There were 269 patients in the IP/RP− group, 420 patients in the IP/RP + group, and 1182 patients in the IP/RP? group. Improved PFS (18.5 vs 16.0 months; P <.0001) and OS (53.3 vs 42.8 months; P <.0001) were associated with RP exploration versus no exploration. Patients with MGRD had improved PFS (16.8 vs 15.1 months, P = 0.0108) and OS (44.9 vs 40.5 months, P = 0.0076) versus no exploration. CONCLUSIONS: RP exploration at the time of primary surgery in patients with optimally debulked stage IIIC EOC is associated with a survival benefit. Cancer 2017;123:985–93.

KW - disease burden

KW - lymphadenectomy

KW - ovarian cancer

KW - retroperitoneal exploration

KW - surgical debulking

UR - http://www.scopus.com/inward/record.url?scp=85003918719&partnerID=8YFLogxK

U2 - 10.1002/cncr.30414

DO - 10.1002/cncr.30414

M3 - Article

C2 - 27864921

AN - SCOPUS:85003918719

SN - 0008-543X

VL - 123

SP - 985

EP - 993

JO - Cancer

JF - Cancer

IS - 6

ER -

What is the role of retroperitoneal exploration in optimally debulked stage IIIC epithelial ovarian cancer? An NRG Oncology/Gynecologic Oncology Group ancillary data study

Abstract

Keywords

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