Impact of surgical complexity on disease-free survival and overall survival in newly diagnosed advanced ovarian cancer.

Autores de IIS La Fe

• Víctor Lago Leal

  Autor

• Blanca Novillo Del Álamo

  Autor

• Marta Arnáez De La Cruz

  Autor

• Iria Rey Ferreira

  Autor

• Pablo Padilla Iserte

  Autor

• Luis Javier Matute Tobias

  Autor

• Marta Gurrea Soteras

  Autor

• Santiago Domingo Del Pozo

  Autor

Grupos

• Grupo de Investigación en tumores ginecológicos, cáncer de mama y cáncer hereditario

• Medicina Fetal y Reproductiva

Abstract

OBJECTIVE: Ovarian cancer surgery and the complexity of the procedure may be measured with the standardized Aletti score. The main objective of this study was to establish the influence of surgical complexity using the Aletti score on disease-free survival and overall survival. METHODS: A retrospective observational study was conducted in a reference gynecologic oncology department, including advanced ovarian cancer patients, newly diagnosed who underwent a primary debulking surgery or interval debulking surgery between January 2010 and December 2019 (stage IIB-IV International Federation of Gynecology and Obstetrics classification), and epithelial histology. Incomplete medical records, loss to follow-up patients, and borderline histologies were excluded. Survival analysis and multivariate analysis were performed. RESULTS: A total of 399 patients were included in the study. Regarding Aletti score complexity, no differences were observed in disease-free survival (median: 25 vs 24 months, p = .5) or overall survival (median: 56 vs 49 months, p = .6). Complete cytoreduction was associated with better disease-free survival (median: complete 26 vs optimal 14 vs sub-optimal 9 months, p < .0001) and overall survival (p < .0001). Furthermore, primary debulking surgery showed statistically better disease-free survival (median: 25 vs 16 months, p < .0001) and overall survival (median: 72 vs 38 months, p < .0001) compared to interval debulking surgery. The multivariable analysis showed that disease-free survival, overall survival, International Federation of Gynecology and Obstetrics classification, CA125 level at diagnosis, cytoreduction classification achieved after surgery, and the Clavien-Dindo complications did not significantly associate with the Aletti score. CONCLUSIONS: Disease-free survival and overall survival were not influenced by the surgical complexity in patients undergoing cytoreduction after the first diagnosis of advanced ovarian cancer. A higher Aletti score was not associated with a higher rate of complications.

Copyright © 2025 European Society of Gynaecological Oncology and the International Gynecologic Cancer Society. Published by Elsevier Inc. All rights reserved.

Keywords

• Cytoreduction; Disease-Free Survival; Ovarian Cancer; Surgery