Predictors of survival in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery based on the pooled analysis of an international collaborative cohort.

BACKGROUND: This study aims to identify prognostic factors and to develop a risk model predicting survival in patients undergoing secondary cytoreductive surgery (SCR) for recurrent epithelial ovarian cancer. METHODS: Individual data of 1100 patients with recurrent ovarian cancer of a progression-free interval at least 6 months who underwent SCR were pooled analysed. A simplified scoring system for each independent prognostic factor was developed according to its coefficient. Internal validation was performed to assess the discrimination of the model. RESULTS: Complete SCR was strongly associated with the improvement of survival, with a median survival of 57.7 months, when compared with 27.0 months in those with residual disease of 0.1-1 cm and 15.6 months in those with residual disease of >1 cm, respectively (P<0.0001). Progression-free interval (≤23.1 months vs >23.1 months, hazard ratio (HR): 1.72; score: 2), ascites at recurrence (present vs absent, HR: 1.27; score: 1), extent of recurrence (multiple vs localised disease, HR: 1.38; score: 1) as well as residual disease after SCR (R1 vs R0, HR: 1.90, score: 2; R2 vs R0, HR: 3.0, score: 4) entered into the risk model. CONCLUSION: This prognostic model may provide evidence to predict survival benefit from secondary cytoreduction in patients with recurrent ovarian cancer.

The role of surgery in the second relapse of epithelial ovarian cancer. Selection criteria, morbidity and survival outcome.

BACKGROUND: The aim of this study was to investigate the benefit of cytoreductive surgery (CS) and palliative surgery (PS) because of bowel obstruction in the second relapse (SR) in epithelial ovarian cancer. METHODS: A retrospective population-based study on recorded information from 490 consecutive patients treated at the Norwegian Radium Hospital during 1985-2001 for their SR. In all, 80 had surgery, 28 and 52 of which had their tertiary surgery (TS) and secondary surgery (SS), respectively and 410 were treated with chemotherapy or other therapy. RESULTS: Median survival time (MST) was nine months for the last group. Complete optimal cytoreduction (COC) was achieved in 56% of the patients operated with CS. At SS and TS 33% and 38%, respectively, achieved COC. MST was 46 versus seven months for 0 versus > 2 cm residual disease. MST for the CS and PS was 31 versus five months, respectively. Twenty-eight percent with CS experienced complications versus 42% with PS including two deaths. On univariate analysis initial stage, residual tumor at first relapse, residual tumor at SR, treatment-free interval from primary treatment to first relapse (TFI 0-1), type of chemotherapy at SR, WHO performance status, ascites, elevated CA 125 values, number of lesions, localization of tumor and tumor size were found to be significant prognostic factors for survival in the surgery group. CONCLUSIONS: The combination of COC, TFI 0-1 > or = 24 months, CA 125 < or = 35, < or = 3 tumor lesions and WHO 1 performance criteria identifies a group of patients with the best overall survival in SR.

The role of secondary cytoreduction in the management of the first relapse in epithelial ovarian cancer.

BACKGROUND: The aim of this study was to investigate the benefit of secondary cytoreduction (SCR) in the first relapse in epithelial ovarian cancer and to attempt to define selection criteria for SCR. PATIENTS AND METHODS: A retrospective population-based study on recorded information from 789 patients treated at the Norwegian Radium Hospital during 1985-2000 for their initial recurrence. In all, 217 had SCR and 572 were treated with chemotherapy alone. RESULTS: Median survival time (MST) was 1.1 years for the chemotherapy group. Complete optimal cytoreduction (COC) was achieved in 35% of all 217 patients, in 49% of the patients operated with debulking intent and in 52% if bowel surgery was done with debulking intent. MST was 4.5 versus 0.7 years for 0 versus>2 cm residual disease, respectively. Residual disease after SCR, treatment-free interval (TFI) and age were found to be prognostic factors for overall survival (OS) in multivariate analysis. Localised tumour was found to be the only significant factor to predict COC. CONCLUSIONS: SCR followed by chemotherapy gives a clear survival benefit compared with chemotherapy and should be offered when the tumour is localised. The combination of COC, TFI >24 months and age

Is the watch and wait approach adequate after comprehensive surgical staging in invasive stage I epithelial ovarian cancer? The Norwegian Radium Hospital experience.

OBJECTIVES: The aim of this study on stage I epithelial ovarian cancer (EOC) was to see if our different treatment policies after 1995, when lymph node staging and paclitaxel were introduced, have affected the survival, try to define risk groups for relapse and who should get adjuvant chemotherapy (AC). METHODS: A retrospective study based on record information from all patients with invasive EOC stage I operated at the Norwegian Radium Hospital (NRH) 1984-2001, in total 252 patients. RESULTS: Total 5-year survival was 83 and 82%, respectively, in both time periods. We found age and histology to be significant prognostic factors for overall survival (OS) (p < 0.01). From 1995 survival was significantly better for those who had been properly staged than for the others (p = 0.02), with a 5-year survival rate of 87 vs 64%. Those who did not get chemotherapy but were staged, had a significantly better overall survival than those who were not (p = 0.02), with a 5-year survival of 93 vs 77%. In the period 1995-2001 the patients who received no adjuvant treatment lived longer than those who underwent chemotherapy and/or radiotherapy (p = 0.03). In the first period 17% had no adjuvant treatment vs 58% in the last. Patients in a high-risk group getting AC had a tendency toward better survival than those who did not (p = 0.08). CONCLUSIONS: Patients with Stage I low and medium risk EOC do not need AC if properly staged. For the high-risk group the optimal AC has not yet been established.

Improved survival for stage IIIC ovarian cancer patients treated at the Norwegian Radium Hospital between 1984 and 2001.

BACKGROUND: The aim of this study was to evaluate the treatment of FIGO Stage IIIC patients who were primarily treated completely or partially at the Norwegian Radium Hospital (NRH) during a 15-year period in order to discover possibilities for improvement of prognosis of advanced ovarian cancer. MATERIALS AND METHOD: A retrospective study based on record information from all patients with epithelial ovarian cancer Stage IIIC treated at NRH from 1985-2000, in total 776 patients. RESULTS: We found age, amount of residual tumour after surgery for primary treatment and type of chemotherapy to be the most significant prognostic factors for overall survival. During the last 5-year period primary surgery was increasingly centralised, and surgery was improved with lymph node staging and use of paclitaxel. Survival was significantly better during the last 5-year period and after macroscopic radical surgery. Also progression-free survival was better with no macroscopic tumour remaining. INTERPRETATION: Improved survival during the last 5-year period is partly attributed to improved surgery and partly to the addition of paclitaxel. We believe that further centralisation of primary surgery for advanced ovarian cancer can contribute to a better prognosis.

Ovarian cancer stage IIIC. Consequences of treatment level on overall and progression-free survival.

BACKGROUND: Maximum cytoreduction at primary surgery has been found to be one of the strongest prognostic factors for survival of ovarian cancer. The aim of the study was to investigate the influence of hospital level (primary vs secondary care centre), number and timing of surgery and chemotherapy on how radical the surgery was at primary treatment of epithelial ovarian cancer Stage IIIC. MATERIAL AND METHODS: A retrospective study based on record information from all patients with epithelial ovarian cancer Stage IIIC treated at the Norwegian Radium Hospital (NRH) 1985-2000, in total 776, subdivided into four groups: 1) Local primary surgery, no direct re-operation at NRH, no interval debulking; 2) local primary surgery, no direct re-operation, but interval debulking after 3-4 courses of chemotherapy at NRH; 3) local primary surgery, direct re-operation at NRH, no interval debulking; 4) primary surgery at NRH. Lymph node biopsies at re-operation in early stages and upgrading of stage where necessary were registered. RESULTS: Whether surgery was radical or not was an independent prognostic factor for overall and progression-free survival. The treatment group was an independent prognostic factor for overall, but not for progression-free survival. Group 3 had significantly the best overall and progression-free survival (p = 0.01 and 0.05). For macroscopically radical surgery both overall and progression-free survival were found significantly better for groups 3, 4 and 1 than for group 2. Most lymph node biopsies were performed during the last period and 28% were upgraded from Stage I and II to IIIC. More patients were referred for primary surgery at NRH during the last 5-year period during which overall survival and time to progression were significantly better. INTERPRETATION: Whether primary surgery is radical or not is a significant prognostic factor for survival and primary surgery is best performed by specialists in gynaecological oncology.

[Acid-base equilibrium in umbilical cord blood. Apgar score and acid-base equilibrium in umbilical cord blood as control parameters during labor]. / Syre-base-status i navleveneblod. Apgar-poeng og syre-base-status i navleveneblod som kontrollparametre i fødselshjelpen.

Umbilical cord venous acid-base state was correlated to Apgar score at 1 and 5 minutes and to cerebral ultrasound and other clinical parameters in 295 consecutive deliveries. We present normal values for the whole sample and for normal vaginal deliveries. Most of the acidotic babies (pH less than 7,24) were clinically healthy (80% did not need intensive care in a neonatal department) and had normal Apgar scores (1 min score greater than 7 = 79% and 5 min score greater than 7 = 94%). Only a few of the babies transferred to the neonatal department were acidotic (13%) and had low Apgar scores (1 min score less than 7 = 15% and 5 min score less than 7 = 6%). The prognostic value of the three parameters for neonatal health is low using our definition of acidosis. It remains to be seen if acidosis without clinical symptoms of any significance has any influence on later development. Acid-base state showed better correlation with the optimal time of second stage of labour than Apgar score did. We found a slightly higher pH and a significantly higher base-excess with a long, as against a short second stage and pushing time. There was no difference between the second stage of delivery and the time of active pushing what concerns pH and base-excess. We do not recommend umbilical cord acid-base state as a routine for all deliveries. It should be used only in selected cases.