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 Jane 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

Research output: Contribution to journalArticle

5 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)985-993
Number of pages9
JournalCancer
Volume123
Issue number6
DOIs
StatePublished - Mar 15 2017

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Disease-Free Survival
Survival
Lymph Nodes
Neoplasms
Ovarian epithelial cancer

Keywords

  • disease burden
  • lymphadenectomy
  • ovarian cancer
  • retroperitoneal exploration
  • surgical debulking

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

What is the role of retroperitoneal exploration in optimally debulked stage IIIC epithelial ovarian cancer? An NRG Oncology/Gynecologic Oncology Group ancillary data study. / Rungruang, Bunja Jane; Miller, Austin; Krivak, Thomas C.; Horowitz, Neil S.; Rodriguez, Noah; Hamilton, Chad A.; Backes, Floor J.; Carson, Linda F.; Friedlander, Michael; Mutch, David G.; Goodheart, Michael J.; Tewari, Krishnansu S.; Wenham, Robert M.; Bookman, Michael A.; Maxwell, G. Larry; Richard, Scott D.

In: Cancer, Vol. 123, No. 6, 15.03.2017, p. 985-993.

Research output: Contribution to journalArticle

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
Rungruang, Bunja Jane ; Miller, Austin ; Krivak, Thomas C. ; Horowitz, Neil S. ; Rodriguez, Noah ; Hamilton, Chad A. ; Backes, Floor J. ; Carson, Linda F. ; Friedlander, Michael ; Mutch, David G. ; Goodheart, Michael J. ; Tewari, Krishnansu S. ; Wenham, Robert M. ; Bookman, Michael A. ; Maxwell, G. Larry ; Richard, Scott D. / What is the role of retroperitoneal exploration in optimally debulked stage IIIC epithelial ovarian cancer? An NRG Oncology/Gynecologic Oncology Group ancillary data study. In: Cancer. 2017 ; Vol. 123, No. 6. pp. 985-993.
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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.",
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author = "Rungruang, {Bunja Jane} 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.}",
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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 Jane

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

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