title: Prognostic factors for recurrence following negative second-look laparotomy in ovarian cancer patients treated with platinum-based chemotherapy.
abstract: Prior studies of the risk of recurrence following negative second-look laparotomy have included patients treated with a variety of chemotherapeutic regimens, including nonplatinum regimens. We have examined the long-term outcome and risk factors for recurrence among a homogeneous group of platinum-treated patients. During the years 1978-1987, 91 patients at Memorial Sloan-Kettering Cancer Center had a negative second-look laparotomy following platinum-based chemotherapy for epithelial ovarian cancer. The mean age at diagnosis was 57 years, with a range of 30 to 79. Distribution by stage was as follows: I, 10; II, 18; III, 57; IV, 6. The mean number of cycles of platinum prior to second-look surgery was 6.3. The mean number of biopsies taken at negative second-look laparotomy was 12. Lymph node biopsies were done in 47/91 (52%) of patients. Median follow-up from the date of second-look laparotomy was 54.6 months among survivors. Forty of ninety-one patients (44%) have had recurrence, almost 40% of which were outside the peritoneal cavity. The mean interval from negative second-look laparotomy to recurrence was 24 months (range, 2-70 months). By multivariate analysis the risk of recurrence was significantly related to stage (P = 0.017), histologic grade (P = 0.041), and the amount of tumor remaining after the first operation for ovarian cancer (P = 0.015). Recurrence by stage was as follows: stage I, 1/10 (10%); stage II, 5/18 (28%); stage III, 31/57 (54%); stage IV, 3/6 (50%). Recurrence by grade was as follows: grade 1, 4/18 (22%); grade 2, 11/28 (39%); grade 3, 25/45 (56%). There was no relationship between the risk of recurrence and the number of cycles of platinum, the number of biopsies performed at second-look, or the number of months from primary surgery to second-look. Patients having negative second-look laparotomy following platinum-based chemotherapy for advanced epithelial ovarian cancer have a substantial risk of recurrence, particularly within the first 3 years. Such patients should be offered participation in clinical trials of consolidation therapy directed against both intraperitoneal and extraperitoneal disease.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
authors.forename: S C
authors.initials: SC
authors.lastname: Rubin
authors.forename: W J
authors.initials: WJ
authors.lastname: Hoskins
authors.forename: P E
authors.initials: PE
authors.lastname: Saigo
authors.forename: D
authors.initials: D
authors.lastname: Chapman
authors.forename: T B
authors.initials: TB
authors.lastname: Hakes
authors.forename: M
authors.initials: M
authors.lastname: Markman
authors.forename: B
authors.initials: B
authors.lastname: Reichman
authors.forename: L
authors.initials: L
authors.lastname: Almadrones
authors.forename: J L
authors.initials: JL
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000368:Aged; D002945:Cisplatin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007813:Laparotomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012307:Risk Factors
chemical_list: D002945:Cisplatin