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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2017

01-06-2017 | Gynecologic Oncology

Trends in Mortality After Primary Cytoreductive Surgery for Ovarian Cancer: A Systematic Review and Metaregression of Randomized Clinical Trials and Observational Studies

Authors: Violante Di Donato, MD, PhD, Evangelos Kontopantelis, PhD, Giovanni Aletti, MD, Assunta Casorelli, MD, Ilaria Piacenti, MD, Giorgio Bogani, MD, Francesca Lecce, MD, Pierluigi Benedetti Panici, MD

Published in: Annals of Surgical Oncology | Issue 6/2017

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Abstract

Background

Primary cytoreductive surgery (PDS) followed by platinum-based chemotherapy is the cornerstone of treatment and the absence of residual tumor after PDS is universally considered the most important prognostic factor. The aim of the present analysis was to evaluate trend and predictors of 30-day mortality in patients undergoing primary cytoreduction for ovarian cancer.

Methods

Literature was searched for records reporting 30-day mortality after PDS. All cohorts were rated for quality. Simple and multiple Poisson regression models were used to quantify the association between 30-day mortality and the following: overall or severe complications, proportion of patients with stage IV disease, median age, year of publication, and weighted surgical complexity index. Using the multiple regression model, we calculated the risk of perioperative mortality at different levels for statistically significant covariates of interest.

Results

Simple regression identified median age and proportion of patients with stage IV disease as statistically significant predictors of 30-day mortality. When included in the multiple Poisson regression model, both remained statistically significant, with an incidence rate ratio of 1.087 for median age and 1.017 for stage IV disease. Disease stage was a strong predictor, with the risk estimated to increase from 2.8% (95% confidence interval 2.02–3.66) for stage III to 16.1% (95% confidence interval 6.18–25.93) for stage IV, for a cohort with a median age of 65 years.

Conclusions

Metaregression demonstrated that increased age and advanced clinical stage were independently associated with an increased risk of mortality, and the combined effects of both factors greatly increased the risk.
Appendix
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Metadata
Title
Trends in Mortality After Primary Cytoreductive Surgery for Ovarian Cancer: A Systematic Review and Metaregression of Randomized Clinical Trials and Observational Studies
Authors
Violante Di Donato, MD, PhD
Evangelos Kontopantelis, PhD
Giovanni Aletti, MD
Assunta Casorelli, MD
Ilaria Piacenti, MD
Giorgio Bogani, MD
Francesca Lecce, MD
Pierluigi Benedetti Panici, MD
Publication date
01-06-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5680-7

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