[Factors affecting disease recurrence and the role of secondary therapies in the management for patients with recurrent ovarian carcinoma].
OBJECTIVE
To identify variants affecting disease recurrence and clarify the role of re-debulking surgery and second-line chemotherapy in the management of recurrent advanced epithelial ovarian cancer (AEOC).


METHODS
One hundred and sixty-seven patients with recurrent AEOC treated in our hospital between Jan. 1986 and Dec. 1997 were retrospectively reviewed. Survival was calculated by Kaplan-Meier method with difference in survival estimated by Log-rank test. Independent prognostic factors were identified by the COX stepwise regression model, and variants associated with disease recurrence were found by logistic stepwise regression methods.


RESULTS
The median age was 51 (range 26-71) years. Sixty patients underwent re-debulking surgery, 23 of them with residual disease </= 1 cm. There was a significant difference in survival between optimal and sub-optimal groups, with an estimated median survival of 20 and 10 months, respectively (chi(2) = 9.42, P = 0.021). When patients with sub-optimal surgical results were compared with those who had chemotherapy alone, there was a significant difference in median survival, 10 vs. 13 months (chi(2) = 4.38, P = 0.036 4). Age of the patients, refractory ascites, second-line chemotherapy, and residual disease after primary surgery were independent prognostic factors of survival identified by COX regression analysis. Logistic stepwise regression analysis revealed that age, platinum-based chemotherapy, neoadjuvant chemotherapy, and the size of residual disease after primary surgical cytoreduction were factors affecting progression-free interval.


CONCLUSIONS
The age at diagnosis, residual disease, first-line chemotherapy, and neoadjuvant chemotherapy are factors affecting disease recurrence. Patients received second-line chemotherapy and with residual disease </= 1 cm after secondary surgery experience a better prognosis than those without receiving second-line chemotherapy or with residual disease > 1 cm after secondary cytoreduction.
Zang
Rongyu
R
Department of Gynecologic Oncology, Cancer Hospital of Fudan University, Shanghai 200032, China.
Zhang
Zhiyi
Z
Cai
Shumo
S
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis