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    2019-10-21

    number of months between the date of
    going NACT-IDS for advanced-stage surgical procedures were performed initiation of chemotherapy and either
    (International Federation of Gynecol- with the goal of optimal debulking ( 1.0 disease progression or death. OS was
    ogy and Obstetrics IIIC-IV) epithelial cm maximal diameter of largest residual defined as the number of months be-
    ovarian/fallopian
    tube/primary r> perito- tumor nodule). Surgical procedures tween the date of Lycopene of chemo-
    neal carcinomas (hereafter referred to as were assigned a complexity score therapy and death from any cause.
    EOC) between January 1, 2010, and July reflecting the difficulty and number of Patients alive and progression-free or
    31, 2015. The study design, outcomes, procedures performed as described by alive with disease were censored for PFS
    and statistical methods for this work are Aletti et al.16 Postoperatively, patients and OS, respectively, at the date of last
    similar to those previously published on were treated with at least 3 cycles of follow-up. The KaplaneMeier method
    a cohort of patients undergoing PDS.15 additional chemotherapy.
    was used to estimate survival curves and
    As such, patients were excluded from Patients were classified into 4 groups log-rank statistics and Cox proportional
    the present study if they underwent PDS based on volume and distribution of hazards regression were used to
    (n¼240), as this has been previously residual disease at the completion of IDS. compare survival data. Associations
    15 Patients also Patients with a CSR of disease were were shown as hazard ratios (HRs) with
    reported on by our group.
    were excluded if they had nonepithelial classified as having CSR. Patients with 95% confidence intervals (95% CIs).
    histology, had low-grade serous histol- any remaining tumor nodule measuring The SPSS version 20.0 statistical pack-
    ogy (n¼1), did not have location/vol- >1 cm in diameter were classified as age (IBM Corp, Armonk, NY) was used
    ume of residual disease documented in suboptimally (SO) debulked. Those with for all statistical analyses.
    1.e2 American Journal of Obstetrics & Gynecology MONTH 2019
    ajog.org GYNECOLOGY Original Research
    Results
    Between January 1, 2010, and July 31, 2015, a total of 270 patients with FIGO stage IIIC and IV EOC were managed with NACT-IDS. Table 1 displays the patient demographics and clinical char-acteristics of the study population. The median age of patients was 65 years (range: 34e89 years), and the majority were white (85.6%) and had an adjusted Charlson Comorbidity Index of 2e3 (49.3%). Most patients had stage III disease (55.9%), and almost all patients had serous histology (92.6%). Table 2 displays operative characteristics and perioperative morbidity for the study population. Groups defined by surgical complexity score included low (59.3%), moderate (34.1%), and high (6.3%). The median hospital length of stay was 6 days (range: 1e27 days), and the rate of readmission within 30 days of surgery was 9.6%.
    The overall rate of optimal cytor-eduction (as traditionally defined as all patients with 1 cm residual disease) was 94.1%, including patients who un-derwent CSR (64.1%) and patients who had gross residual disease zygomycetes was 1 cm in greatest diameter (30.0%). Among patients who had gross residual disease that was 1 cm diameter, the number of anatomic sites (single location vs multi-ple locations) with residual tumor nod-ule(s) was used as a surrogate for volume of residual disease. In the entire group, 12.6% of patients had 1 cm of residual disease confined to a single anatomic site, and 17.4% of patients had 1 cm of residual disease that involved multiple sites.