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Influence of Intraperitoneal Dissemination Assessed by Laparoscopy on Prognosis of Advanced Ovarian Cancer: An Exploratory Analysis of a Single-Institution Experience

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to investigate whether preoperative laparoscopic evaluation of the dissemination of disease may have an independent impact on survival in advanced epithelial ovarian cancer (AEOC).

Methods

All AEOC women were submitted to staging laparoscopy before receiving primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT). All study women received a laparoscopic score (predictive index value [PIV]) and were stratified into three groups based on volume of disease: high tumor load (HTL) for PIV ≥8, intermediate tumor load (ITL) for PIV equal to 6 and 4, and low tumor load (LTL) for PIV <4. Surgical and survival outcome were evaluated by univariate and multivariate analysis.

Results

Among 348 consecutive patients, almost half (48.0 %) had an HTL. Among 165 cases receiving PDS, residual tumor (RT) was as follows: no gross residual in 102 patients (61.8 %); RT ≤1 cm in 48 patients (29.1 %) and RT >1 cm in 15 cases (9.1 %). When stratifying the whole population according to laparoscopic tumor load, the median progression-free survival (PFS) was 33 months for LTL, 18 months for ITL, and 14 months for HTL (p = 0.0001). The median overall survival (OS) with respect to laparoscopic PIV was not reached for LTL, whereas it was 47 months for ITL and 33 months for HTL, respectively (p = 0.0001). At multivariate analysis, tumor load stratified by PIV retained an independent prognostic value on PFS and OS, together with RT and performance status.

Conclusions

RT remains an important prognostic factor in patients with AEOC, but tumor dissemination can play a role in determining prognosis in these women.

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Disclosure

Giuseppe Vizzielli, B. Costantini, L. Tortorella, M. Petrillo, F. Fanfani, V. Chiantera, A. Ercoli, R. Iodice, G. Scambia, and A. Fagotti declare no conflicts of interest.

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Authors and Affiliations

  1. Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy

    Giuseppe Vizzielli MD, Barbara Costantini MD, Lucia Tortorella MD, Marco Petrillo MD, Raffaella Iodice MD & Giovanni Scambia MD

  2. Division of Gynecologic Oncology, Foundation for Research and Care “John Paul II”, Campobasso, Italy

    Giuseppe Vizzielli MD & Vito Chiantera MD

  3. Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, Trieste, Italy

    Francesco Fanfani MD

  4. Department of Gynecology, Abano Terme Hospital, Padua, Italy

    Alfredo Ercoli PhD

  5. Division of Minimally Invasive Gynecologic Surgery, St. Maria Hospital, University of Perugia, Terni, Italy

    Anna Fagotti PhD

Authors
  1. Giuseppe Vizzielli MD
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  2. Barbara Costantini MD
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  3. Lucia Tortorella MD
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  4. Marco Petrillo MD
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  5. Francesco Fanfani MD
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  6. Vito Chiantera MD
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  7. Alfredo Ercoli PhD
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  8. Raffaella Iodice MD
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  9. Giovanni Scambia MD
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  10. Anna Fagotti PhD
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Correspondence to Giuseppe Vizzielli MD.

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Vizzielli, G., Costantini, B., Tortorella, L. et al. Influence of Intraperitoneal Dissemination Assessed by Laparoscopy on Prognosis of Advanced Ovarian Cancer: An Exploratory Analysis of a Single-Institution Experience. Ann Surg Oncol 21, 3970–3977 (2014). https://doi.org/10.1245/s10434-014-3783-6

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  • DOI: https://doi.org/10.1245/s10434-014-3783-6

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