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abstract
Background
The absence of
disease after debulking surgery is the most important prognostic factor
in the treatment of advanced epithelial ovarian cancer (EOC).
Occasionally, the presence of extra-abdominal disease complicates the
ability to obtain a complete surgery, considering some locations of the
metastatic disease as unresectable. The objective of the study was to
estimate the survival impact of pelvic retroperitoneal invasion and
extrapelvic and aortic distant nodal metastases in EOC patients. The
anatomical landmarks of primary cytoreductive surgery will be discussed.
Material and methods
we
reviewed data from 116 consecutive Mayo Clinic patients with epithelial
ovarian cancer (EOC) stage IIIC and IV, undergoing primary
cytoreduction surgery between 1996 and 2000. Univariate and multivariate
analysis for patients with positive distant nodes and pelvic
retroperitoneal invasion was performed, including 57 patients with no
residual disease after surgery. Kaplan-Meier curves were used to
estimate the probability of survival.
Results
the
median patient's age was 65 years (range 24-87 years). The 5 years
overall survival was 44.8% (range 30.1-57.9 months) and the median
length of survival was 39.9 months (range 0.13-60 months, 95% confidence
interval: 30.1-57.9). Pelvic retroperitoneal invasion was present in 22
EOC patients (18.9%) and distant positive nodes were noted in 11
(9.5%): suprarenal/celiac (5.2%), inguinal (4.3%) and supraclavicular
(0.9%). Univariate and multivariate Cox regression analysis, identified
distant positive lymph nodes and pelvic retroperitoneal invasion as
factors statistically associated with overall survival (p=0.002 and
p=0.025, respectively).
Conclusions
metastatic
distant nodes and pelvic retroperitoneal invasion are independent
prognostic factors for survival in patients with advanced EOC.
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