Effect of obesity on survival in epithelial ovarian cancer.

BACKGROUND: Epidemiologic studies suggest that obese women are more likely to die of ovarian cancer than those of ideal body weight, but it is not known whether increased incidence, comorbidities common to obese women, or altered tumor biology is responsible for this difference. The current study attempted to determine the influence of excess body weight on ovarian cancer survival, disease progression, and clinicopathologic factors. METHODS: The records of patients undergoing surgery for epithelial ovarian cancer at Cedars Sinai Medical Center between January 1, 1996 and June 30, 2003 were reviewed for height, weight, age, comorbidities, and treatment-specific details. Statistical analyses included the Fisher exact test, Kaplan-Meier survival, and Cox regression analyses. RESULTS: In all, 216 patients were identified. Eight percent were underweight (body mass index [BMI] < 18.5), 50% were ideal body weight (18.5 /= 30). Age, comorbidities including coronary artery disease and venous thromboembolism, and rates of optimal surgical cytoreduction were similar among BMI strata. Diabetes and hypertension were more common in obese women. Ten (29%) of the obese patients had International Federation of Gynecology and Obstetrics (FIGO) Stage I disease, compared with 19 (10%) of the patients with BMI < 30 (P = .01). In a subcohort of 149 patients with Stage III or IV disease, a significant trend was identified favoring increased BMI as an independent negative factor for disease-free (P = .02) and overall (P = .02) survival. CONCLUSIONS: Obese patients were more likely to have disease limited to the ovaries. For patients with advanced stage disease, obesity was independently associated with both shorter time to recurrence and shorter overall survival. These findings suggest an effect of excess body weight on tumor biology, and studies are under way to elucidate the molecular and hormonal mechanisms underlying these clinical observations.

Pelvic exenteration for recurrent gynecologic malignancy: survival and morbidity analysis of the 45-year experience at UCLA.

OBJECTIVE: To retrospectively assess the outcome of patients undergoing pelvic exenteration for recurrent or persistence gynecologic malignancy and the clinical features associated with outcome and survival. METHODS: A review was conducted of patients who underwent pelvic exenteration over a 45-year period (1956-2001) at the UCLA Medical Center. Numerous clinical variables were analyzed, including time to relapse, type of exenteration and reconstructive operation, early (<60 days) and late (>60 days) morbidity, and survival. Variables were analyzed by chi-square and life-table analysis. RESULTS: Seventy-five patients (ages 26-74 years) had persistent cervical and vaginal (67) and uterine (8) cancer. Forty-six patients underwent total exenteration, 23 anterior, and 6 posterior. Sixty-nine (92%) patients underwent urinary diversion or neocystoplasty, 54 (72%) patients had a simultaneous neovagina created, and 43 of 52 (83%) patients who had a low colon resection had a primary reanastomosis. Twenty-nine patients died from recurrent malignancy, 28 were alive without disease, 11 were alive with disease, and 7 died from other causes at last follow-up. Survival for patients with cervical and vaginal cancer was 73% at 1 year, 57% at 3 years, and 54% at 5 years. Survival for patients with uterine cancer was 86% at 1 year, 62% at 3 and 5 years. The most frequent early morbidity was urinary tract infection, wound infection, and intestinal fistula; the most frequent late morbidity was urinary tract infection and intestinal obstruction. CONCLUSION: Pelvic exenteration in patients with recurrent cervical and vaginal malignancy is associated with a durable > 50% 5-year survival. Simultaneously performed pelvic reconstructive operations with a continent urinary diversion, the creation of a neovagina, and the reanastomosis of the colon with the formation of a J-pouch is now our standard; and these operations tend to improve the outcome of patients. Based on our initial experience, recurrent uterine corpus cancer in young women (< 55 years) should be included as an indication for the surgery.

Lower urinary tract reconstruction with ileum in the treatment of gynecologic malignancies.

INTRODUCTION: Advanced or recurrent gynecologic malignancies can invade or obstruct the lower urinary tract. If extirpation is necessary for cytoreduction or repair of radiation sequelae, treatment has typically involved creation of either an ileal conduit or a cutaneous continent urinary diversion. As an alternative, a more limited resection with urinary tract reconstruction using ileum for interposition or augmentation may allow for the preservation of urethral voiding. CASES: We describe the use of ileal segments for lower urinary tract reconstruction in the treatment of ten patients with advanced or recurrent gynecologic malignancies. The clinical history, surgical technique, and patient outcomes are reviewed. DISCUSSION: These cases demonstrate that limited bladder or ureteral resection with reconstruction using ileal segments may offer select patients preservation of urethral voiding.

The prognostic significance of thrombocytosis in epithelial ovarian carcinoma.

OBJECTIVE: The objective of this study was to determine the incidence of thrombocytosis in epithelial ovarian carcinoma and examine associations with clinico-pathologic features. Thrombocytosis (platelet counts >400 x 10(9)/l) has been identified as a poor prognostic factor in many cancers. Platelet-secreted factors may contribute to metastasis, invasion, and primary tumor growth. METHODS: One hundred eighty-three patients with invasive epithelial ovarian or primary peritoneal carcinomas were identified between January 1996 and December 2000. Records were retrospectively reviewed and data analyzed using chi(2), Student's t test, and Cox proportional hazards model; survival was analyzed by the method of Kaplan and Meier. RESULTS: Forty-one of 183 (22.4%) patients had thrombocytosis at primary diagnosis. Patients with preoperative thrombocytosis were found to have greater elevations of CA-125 (P = 0.026), more advanced stage disease (P = 0.016), higher grade tumors (P = 0.010), more frequent lymph node metastases (P = 0.018), and greater volume of ascites (P < 0.0001). One hundred sixty of 183 (87.4%) patients achieved optimal cytoreduction; patients with thrombocytosis demonstrated a greater likelihood of suboptimal resection (residual disease >1 cm; 19/41 vs. 4/142 in patients without thrombocytosis, P < 0.0001). Patients with thrombocytosis had a shorter disease-free interval (12 vs. 34 months, P < 0.0001) and overall survival (28 vs. 79 months, P < 0.0001). On multivariate analysis, thrombocytosis retained significance as a poor prognostic indicator in patients with stage III and IVA disease (P = 0.04). CONCLUSIONS: Thrombocytosis is a frequent preoperative finding in ovarian and peritoneal carcinomas and may be a marker of aggressive tumor biology.