Multidisciplinary Surgical Approach to Increase Survival for Advanced Ovarian Cancer in a Tertiary Gynaecological Oncology Centre.

Autor: Mulligan K; UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland., Corry E; UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland., Donohoe F; UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland., Glennon K; UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland., Vermeulen C; UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland., Reid-Schachter G; UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland., Thompson C; UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland., Walsh T; UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland., Shields C; Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.; National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland., McCormack O; Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.; National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland., Conneely J; Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.; National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland., Khan MF; Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.; National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland., Boyd WD; UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland., McVey R; UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.; Department of Gynaecology, St Vincent's Hospital, Elm Park, Dublin 4, Ireland., O'Brien D; Department of Gynaecology, St Vincent's Hospital, Elm Park, Dublin 4, Ireland., Treacy A; Department of Pathology, Mater Misericordiae University Hospital, Dublin 7, Ireland., Mulsow J; Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.; National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland., Brennan DJ; UCD Gynaecological Oncology Group, Catherine McAuley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. donal.brennan@ucd.ie.; National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland. donal.brennan@ucd.ie.; Department of Gynaecology, St Vincent's Hospital, Elm Park, Dublin 4, Ireland. donal.brennan@ucd.ie.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Jan; Vol. 31 (1), pp. 460-472. Date of Electronic Publication: 2023 Oct 24.
DOI: 10.1245/s10434-023-14423-1
Abstrakt: Purpose: The purpose of this paper is to report on changes in overall survival, progression-free survival, and complete cytoreduction rates in the 5-year period after the implementation of a multidisciplinary surgical team (MDT).
Methods: Two cohorts were used. Cohort A was a retrospectively collated cohort from 2006 to 2015. Cohort B was a prospectively collated cohort of patients from January 2017 to September 2021.
Results: This study included 146 patients in cohort A (2006-2015) and 174 patients in cohort B (2017-2021) with FIGO stage III/IV ovarian cancer. Median follow-up in cohort A was 60 months and 48 months in cohort B. The rate of primary cytoreductive surgery increased from 38% (55/146) in cohort A to 46.5% (81/174) in cohort B. Complete macroscopic resection increased from 58.9% (86/146) in cohort A to 78.7% (137/174) in cohort B (p < 0.001). At 3 years, 75% (109/144) patients had disease progression in cohort A compared with 48.8% (85/174) in cohort B (log-rank, p < 0.001). Also at 3 years, 64.5% (93/144) of patients had died in cohort A compared with 24% (42/174) of cohort B (log-rank, p < 0.001). Cox multivariate analysis demonstrated that MDT input, residual disease, and age were independent predictors of overall (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.203-0.437, p < 0.001) and progression-free survival (HR 0.31, 95% CI 0.21-0.43, p < 0.001). Major morbidity remained stable throughout both study periods (2006-2021).
Conclusions: Our data demonstrate that the implementation of multidisciplinary-team, intraoperative approach allowed for a change in surgical philosophy and has resulted in a significant improvement in overall survival, progression-free survival, and complete resection rates.
(© 2023. Society of Surgical Oncology.)
Databáze: MEDLINE
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