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Personalized surgical therapy for advanced ovarian cancer: R0 resection after neoadjuvant chemotherapy is associated with decreased event-free survival compared with primary cytoreductive surgery
Abstracts / Gynecologic Oncology 141 (2016) 2–208
reflect a disparity in access to gynecologic oncology subspecialists. There is a critical need to decrease the prevalence and effects of such disparities.
181
P = .041), and administration of NACT (HR 1.84, 95% CI 1.11–3.04, P = .019). Stage as a surrogate marker for tumor burden was not associated with EFS. Conclusions: Despite high rates of R0 cytoreduction at the time of IDS, patients undergoing NACT have decreased EFS than those undergoing PDS. Predicting those patients likely to achieve R0 resection in the upfront setting is important for maximizing patient outcomes. doi:10.1016/j.ygyno.2016.04.467
OF
436 – Poster Venous thromboembolism after minimally invasive surgery for gynecologic malignancy: A NSQIP database analysis P.C. Mayor, J.B. Szender, E. Zsiros, P.J. Frederick, S.B. Lele, K.O. Odunsi. Roswell Park Cancer Institute, Buffalo, NY, USA
RO
Objectives: To determine the overall incidence of venous thromboembolism (VTE) in patients undergoing minimally invasive surgery (MIS) for cervical and endometrial cancer Methods: We inspected the National Surgical Quality Improvement Program (NSQIP) participant use files from 2007 to 2013 for subjects undergoing minimally invasive surgery (CPT codes 58500–58599) for endometrial and cervical cancers (ICD-9 codes 179, 180, 182). The primary outcome measured was diagnosis of VTE within 30 days of surgery. Features available in the database consistent with the American College of Obstetricians and Gynecologists (ACOG) recommendations for 30-day postsurgical thromboprophylaxis were evaluated and included active cancer diagnosis and body mass index (BMI) greater than or equal to 30 kg/m2. The American Society of Clinical Oncology (ASCO) recommendations for 30-day postsurgical thromboprophylaxis were also evaluated, and included active cancer diagnosis and age greater than 60 years. Variables were compared using a χ2 test with a nominal value of P b .05 as a test for significance. Results: We identified 6,918 subjects who underwent MIS for gynecologic malignancy. Of these, 91% had endometrial cancer and 9% had cervical cancer. We identified 50 VTEs within 30 days of surgery, for a rate of 0.72%. The rate of VTE in was 0.24% normalweight subjects and 0.97% in in obese subjects. The rate of VTE was 0.28% in subjects younger than 60 years and 1.04% in those aged 60 years and older. We analyzed high-risk features available in the dataset as recommended by ASCO and the relative risk of VTE increased 4-fold (RR 4.04, 95% CI 1.25–12.97). We analyzed high-risk features available in the dataset as recommended by ACOG and the relative risk increased by more than 3-fold (RR 3.71, 95% CI 1.7–7.9). We combined ACOG and ASCO high-risk features available in the dataset and the relative risk increased 3-fold (RR 3.6, 95% CI 2.01– 6.46). Conclusions: The overall incidence of VTE within 30 days of minimally invasive surgery for endometrial and cervical cancer is low. The existing 30-day risk prediction models proposed by ACOG and ASCO are able to predict a statistically significant increased risk of VTE in patients undergoing minimally invasive surgery for cervical and endometrial cancer in this large national dataset.
Fig. 1. Epitheial Ovarian Cancer Survival.
DP
doi:10.1016/j.ygyno.2016.04.466
TE
435 – Poster Personalized surgical therapy for advanced ovarian cancer: R0 resection after neoadjuvant chemotherapy is associated with decreased event-free survival compared with primary cytoreductive surgery A.M. Nick, R.L. Coleman, P.T. Ramirez, K.H. Lu, K.M. Schmeler, J.K. Burzawa, P.T. Soliman, K.M. Rangel, M.F. Munsell, A.K. Sood. The University of Texas MD Anderson Cancer Center, Houston, TX, USA
UN
CO
RR
EC
Objectives: To determine differences in survival among patients who undergo complete gross resection (R0) after primary cytoreductive surgery (PDS) compared with interval cytoreductive surgery (IDS). Methods: Standard practice at our institution is to have all patients with advanced ovarian cancer (OC) undergo a triage algorithm to determine those who should receive PDS versus neoadjuvant chemotherapy (NACT) followed by IDS. Using a previously described algorithm, preoperatively defined parameters are analyzed using laparoscopy (LS) to determine who should be offered PDS. Patient outcomes were tracked prospectively. The Fisher exact test and Wilcoxon rank sum test were used to compare medians among patients with PDS versus IDS. Event-free survival (EFS) was defined as months from the date of diagnosis to the date of first recurrence, progressive disease, or death. Prognostic factors associated with EFS were evaluated with Cox proportional hazards regression. Results: Between April 2013 and September 2015, 206 patients with suspected advanced OC presented to our center. Of these, 119 were offered LS; 88% had serous histology; 132 (64%) patients had stage III disease; and 74 (36%) had stage IV disease, with more patients in the NACT group having stage IV disease (10% vs 51%, P b .001). Rates of R0 resection were similar between the PDS and IDS groups (87% [n = 65] vs 83% [n = 85], P = .521). Compared with patients who underwent PDS, those who had IDS had higher pretreatment CA-125 levels (675 vs 247, P b .001) and platelet counts (379 vs 303 × 109/L, P b .001). EFS was longer in the PDS group (20.8 months) compared with the IDS group (13.8 months, P = .002). Factors associated with decreased EFS on multivariate analysis include Charlson Comorbidity Index N3 (HR 2.20, 95% CI 1.30–3.72, P = .003), pretreatment CA-125 higher than 73 (HR 3.02, 95% CI 1.16–7.85, P = .032), pretreatment platelet counts greater than 306 × 109/L (HR 1.70, 95% CI 1.02–2.82,
doi:10.1016/j.ygyno.2016.04.468
437 – Poster Has robotic hysterectomy increased the need for gynecologic oncologists? K.M. Wishalla, K. Yatesb, T.C. Krivakc, S.D. Richarda. aHahnemann University Hospital/Drexel University College of Medicine, Philadelphia, PA, USA, bWest Penn Allegheny Health System, Pittsburgh, PA, USA, c Western Pennsylvania Hospital, Pittsburgh, PA, USA
reflect a disparity in access to gynecologic oncology subspecialists. There is a critical need to decrease the prevalence and effects of such disparities.
181
P = .041), and administration of NACT (HR 1.84, 95% CI 1.11–3.04, P = .019). Stage as a surrogate marker for tumor burden was not associated with EFS. Conclusions: Despite high rates of R0 cytoreduction at the time of IDS, patients undergoing NACT have decreased EFS than those undergoing PDS. Predicting those patients likely to achieve R0 resection in the upfront setting is important for maximizing patient outcomes. doi:10.1016/j.ygyno.2016.04.467
OF
436 – Poster Venous thromboembolism after minimally invasive surgery for gynecologic malignancy: A NSQIP database analysis P.C. Mayor, J.B. Szender, E. Zsiros, P.J. Frederick, S.B. Lele, K.O. Odunsi. Roswell Park Cancer Institute, Buffalo, NY, USA
RO
Objectives: To determine the overall incidence of venous thromboembolism (VTE) in patients undergoing minimally invasive surgery (MIS) for cervical and endometrial cancer Methods: We inspected the National Surgical Quality Improvement Program (NSQIP) participant use files from 2007 to 2013 for subjects undergoing minimally invasive surgery (CPT codes 58500–58599) for endometrial and cervical cancers (ICD-9 codes 179, 180, 182). The primary outcome measured was diagnosis of VTE within 30 days of surgery. Features available in the database consistent with the American College of Obstetricians and Gynecologists (ACOG) recommendations for 30-day postsurgical thromboprophylaxis were evaluated and included active cancer diagnosis and body mass index (BMI) greater than or equal to 30 kg/m2. The American Society of Clinical Oncology (ASCO) recommendations for 30-day postsurgical thromboprophylaxis were also evaluated, and included active cancer diagnosis and age greater than 60 years. Variables were compared using a χ2 test with a nominal value of P b .05 as a test for significance. Results: We identified 6,918 subjects who underwent MIS for gynecologic malignancy. Of these, 91% had endometrial cancer and 9% had cervical cancer. We identified 50 VTEs within 30 days of surgery, for a rate of 0.72%. The rate of VTE in was 0.24% normalweight subjects and 0.97% in in obese subjects. The rate of VTE was 0.28% in subjects younger than 60 years and 1.04% in those aged 60 years and older. We analyzed high-risk features available in the dataset as recommended by ASCO and the relative risk of VTE increased 4-fold (RR 4.04, 95% CI 1.25–12.97). We analyzed high-risk features available in the dataset as recommended by ACOG and the relative risk increased by more than 3-fold (RR 3.71, 95% CI 1.7–7.9). We combined ACOG and ASCO high-risk features available in the dataset and the relative risk increased 3-fold (RR 3.6, 95% CI 2.01– 6.46). Conclusions: The overall incidence of VTE within 30 days of minimally invasive surgery for endometrial and cervical cancer is low. The existing 30-day risk prediction models proposed by ACOG and ASCO are able to predict a statistically significant increased risk of VTE in patients undergoing minimally invasive surgery for cervical and endometrial cancer in this large national dataset.
Fig. 1. Epitheial Ovarian Cancer Survival.
DP
doi:10.1016/j.ygyno.2016.04.466
TE
435 – Poster Personalized surgical therapy for advanced ovarian cancer: R0 resection after neoadjuvant chemotherapy is associated with decreased event-free survival compared with primary cytoreductive surgery A.M. Nick, R.L. Coleman, P.T. Ramirez, K.H. Lu, K.M. Schmeler, J.K. Burzawa, P.T. Soliman, K.M. Rangel, M.F. Munsell, A.K. Sood. The University of Texas MD Anderson Cancer Center, Houston, TX, USA
UN
CO
RR
EC
Objectives: To determine differences in survival among patients who undergo complete gross resection (R0) after primary cytoreductive surgery (PDS) compared with interval cytoreductive surgery (IDS). Methods: Standard practice at our institution is to have all patients with advanced ovarian cancer (OC) undergo a triage algorithm to determine those who should receive PDS versus neoadjuvant chemotherapy (NACT) followed by IDS. Using a previously described algorithm, preoperatively defined parameters are analyzed using laparoscopy (LS) to determine who should be offered PDS. Patient outcomes were tracked prospectively. The Fisher exact test and Wilcoxon rank sum test were used to compare medians among patients with PDS versus IDS. Event-free survival (EFS) was defined as months from the date of diagnosis to the date of first recurrence, progressive disease, or death. Prognostic factors associated with EFS were evaluated with Cox proportional hazards regression. Results: Between April 2013 and September 2015, 206 patients with suspected advanced OC presented to our center. Of these, 119 were offered LS; 88% had serous histology; 132 (64%) patients had stage III disease; and 74 (36%) had stage IV disease, with more patients in the NACT group having stage IV disease (10% vs 51%, P b .001). Rates of R0 resection were similar between the PDS and IDS groups (87% [n = 65] vs 83% [n = 85], P = .521). Compared with patients who underwent PDS, those who had IDS had higher pretreatment CA-125 levels (675 vs 247, P b .001) and platelet counts (379 vs 303 × 109/L, P b .001). EFS was longer in the PDS group (20.8 months) compared with the IDS group (13.8 months, P = .002). Factors associated with decreased EFS on multivariate analysis include Charlson Comorbidity Index N3 (HR 2.20, 95% CI 1.30–3.72, P = .003), pretreatment CA-125 higher than 73 (HR 3.02, 95% CI 1.16–7.85, P = .032), pretreatment platelet counts greater than 306 × 109/L (HR 1.70, 95% CI 1.02–2.82,
doi:10.1016/j.ygyno.2016.04.468
437 – Poster Has robotic hysterectomy increased the need for gynecologic oncologists? K.M. Wishalla, K. Yatesb, T.C. Krivakc, S.D. Richarda. aHahnemann University Hospital/Drexel University College of Medicine, Philadelphia, PA, USA, bWest Penn Allegheny Health System, Pittsburgh, PA, USA, c Western Pennsylvania Hospital, Pittsburgh, PA, USA