J.K. Lauer

The survival detriment of venous thromboembolism with epithelial ovarian cancer.

OBJECTIVE The aim of this study is to evaluate the effect of venous thromboembolism (VTE) chronology with respect to surgery on survival with epithelial ovarian cancer (EOC). METHODS An IRB approved, retrospective review was performed of patients treated for Stage I-IV EOC from 1996 to 2011. Cox proportional hazards model was used to assess associations between VTE and the primary outcomes of progression free survival (PFS) and overall survival (OS). SAS 9.3 was used for statistical analyses. RESULTS 586 patients met study criteria. Median age was 63 years (range, 17-94); median BMI was 27.1 kg/m(2) (range, 13.7-67.0). Most tumors were high grade serous (68.3%) and advanced stage (III/IV, 75.4%). 3.7% had a preoperative VTE; 13.2% had a postoperative VTE. Upon multivariate analysis adjusting for age, stage, histology, performance status, and residual disease, preoperative VTE was predictive of OS (HR 3.1, 95% CI: 1.6-6.1, p=0.001) but not PFS (p=0.55). Postoperative VTE was associated with shorter PFS (HR 1.45, 95% CI: 1.04-2.02, p=0.03) and OS (HR 1.8, 95% CI: 1.3-2.6, p=0.001). When VTE timing was modeled, preoperative VTE (HR 3.5, 95% CI: 1.8-6.9, p<0.001) and postoperative VTE after primary therapy (HR 2.3, 95% CI: 1.4-3.6, p=0.001) were predictive of OS. CONCLUSION Preoperative and postoperative VTE appear to have a detrimental effect on OS with EOC. When modeled as a binary variable, postoperative VTE attenuated PFS; however, when VTE timing was modeled, postoperative VTE was not associated with PFS. It is unclear whether VTE is an inherent poor prognostic marker or if improved VTE prophylaxis and treatment may enable similar survival to patients without these events.

Primary and acquired platinum-resistance among women with high grade serous ovarian cancer

OBJECTIVE Women with primary platinum resistant (PPR) high grade serous ovarian cancer (HGSOC) are known to have a poor prognosis. Less is known regarding outcomes in patients with acquired platinum resistance (APR). The goal of this study was to evaluate survival in both PPR and APR patients. METHODS A retrospective review of HGSOC patients diagnosed between 2000 and 2010 was performed. Descriptive statistics summarized clinical characteristics and demographics. The Kaplan-Meier method estimated progression free survival (PFS) and overall survival (OS). The association of OS and clinical factors was modeled using Cox proportional-hazards. RESULTS Of the 330 patients identified, 81 (25%) had PPR. Of the remaining women, 55 (22%) developed APR. Median PFS of PPR patients was 4.2months and median OS was 17.8months. On multivariate analysis, the number of biologic agents received was the only predictor of OS. Patients with APR had a median PFS of 14.2months and a median OS of 56months. OS from the date of platinum resistance was 21.9months, though this was not different than PPR patients (p=0.19). Multivariate analysis found cancer stage and clinical trial participation to be associated with OS. CONCLUSIONS Platinum resistance confers a poor prognosis in the APR and PPR setting. The number of biologic agents received is the strongest predictor of OS among women with PPR. Cancer stage and clinical trial participation predicts OS in patients with APR. Providing opportunities to participate in clinical trials, especially those involving targeted therapy, should be a priority in these populations.

Inpatient versus outpatient management of neutropenic fever in gynecologic oncology patients: Is risk stratification useful?

OBJECTIVE This study aimed to evaluate the utility of risk stratification of gynecologic oncology patients with neutropenic fever (NF). METHODS A retrospective chart review of gynecologic cancer patients admitted with NF from 2007 to 2011 was performed, wherein demographic, oncologic, and NF characteristics (hospitalization length, complications, and death) were collected. The Multinational Association for Supportive Care in Cancer (MASCC) risk index score was calculated; low risk was considered ≥ 21. SAS 9.2 was used for statistical analyses. RESULTS Eighty-three patients met the study criteria. Most (92%) were Caucasian and had advanced stage disease (71%). Primary tumors were 58% ovary, 35% endometrium, and 6% cervix. All patients were receiving chemotherapy on admission (72% for primary, 28% for recurrent disease). Forty-eight percent had a positive culture, and most (58%) positive cultures were urine. Seventy-six percent of patients were considered low risk. High-risk patients were more likely to have a severe complication (10% versus 50%, p=0.0003), multiple severe complications (3% versus 20%, p=0.0278), ICU admission (2% versus 40%, p<0.0001), overall mortality (2% versus 15%, p=0.0417), and death due to neutropenic fever (0% versus 15%, p=0.0124). MASCC had a positive predictive value of 50% and negative predictive value of 90%. The median MASCC score for all patients was 22 (range, 11-26), but the median MASCC score for those with death or a severe complication was 17 (range, 11-24). CONCLUSION Based on this pilot data, MASCC score appears promising in determining suitability for outpatient management of NF in gynecologic oncology patients. Prospective study is ongoing to confirm safety and determine impact on cost.

The use of biologic agents and clinical trials may prolong survival for women with primary platinum resistant ovarian carcinoma

Hispanic (8%), Asian (4%), and other races (3%). 29% were from the South, 26% from the Midwest, 25% Northeast, and 21% were from the West. 23% of hospitals were higher volume (N20 cases/year) vs. lower volume hospitals. 1647 (25%) underwent robotic surgery (RS), 820 (12%) laparoscopic (LS), vs. 4093 (62%) had open surgery (OS). The older (N 62 years, median) were more likely to have RS compared to younger (26% vs. 24%, p = 0.02). 29% of Whites had RS compared to only 20% Native Americans, 15% Hispanics, 12% Blacks, and 11% of Asians (p b 0.01). Patients from Midwest, Northeast, South and West had RS in 26%, 26%, 25%, and 23% of cases. Higher volume hospital performed 72% of all surgeries and 84% of all RS. Moreover, these higher volume hospitals were more likely to use RS compared to lower volume institutions (29% vs. 14%, p b 0.01). Those with low(b

The survival detriment of venous thromboembolism with epithelial ovarian cancer

40,999),middle (

Acquired platinum resistance among women with high-grade serous epithelial ovarian cancer

41,000–

The influence of obesity on disease characteristics and survival among patients with epithelial ovarian cancer

50,999), upper middle (

Characterization of primary platinum resistance in an era of biologic agents and novel chemotherapeutic design

51,000–

Predictors of survival following recurrence of cervical cancer

66,999), and high (N

Venous thromboembolism carries a particularly grave prognosis with epithelial ovarian cancer

67,000) socioeconomic had RS in 21%, 25%, 28%, and 27% of cases (p b 0.01). Those with Medicare orprivate insurance were more likelyto receive RS at 27% and 26% vs. 14% of Medicaid patients (p b 0.01). Conclusions: In this nationwide analysis of endometrial cancer patients, older, Whites, higher socioeconomic class, receiving care from higher volume hospitals were associated with likelihood of receiving robotic surgery. Further studies are warranted to better understand the barriers of receiving robotic surgery.