title: Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from an international comparison within the SCOTROC-1 Trial.
abstract: OBJECTIVE
  Studies indicate that ovarian cancer patients who have been optimally debulked survive longer. Although chemotherapy has been variable, they have defined standards of care. Additionally, it is suggested that patients from the United Kingdom (UK) have inferior survival compared with some other countries. We explored this within the context of a large, international, prospective, randomized trial of first-line chemotherapy in advanced ovarian cancer (docetaxel-carboplatin v paclitaxel-carboplatin; SCOTROC-1). The Scottish Randomised Trial in Ovarian Cancer surgical study is a prospective observational study examining the impact on progression-free survival (PFS) of cytoreductive surgery and international variations in surgical practice.
  
  
  METHODS
  One thousand seventy-seven patients were recruited (UK, n = 689; Europe, United States, and Australasia, n = 388). Surgical data were available for 889 patients. These data were analyzed within a Cox model.
  
  
  RESULTS
  There were three main observations. First, more extensive surgery was performed in non-UK patients, who were more likely to be optimally debulked (< or = 2 cm residual disease) than UK patients [corrected] (71.3% v 58.4%, respectively; P < .001). Second, optimal debulking was associated with increased PFS mainly for patients with less extensive disease at the outset (test for interaction, P = .003). Third, UK patients with no visible residual disease had a less favorable PFS compared with patients recruited from non-UK centers who were similarly debulked (hazard ratio = 1.85; 95% CI, 1.16 to 2.97; P = .010). This observation seems to be related to surgical practice, primarily lymphadenectomy.
  
  
  CONCLUSIONS
  Increased PFS associated with optimal surgery is limited to patients with less advanced disease, arguing for case selection rather than aggressive debulking in all patients irrespective of disease extent. Lymphadenectomy may have beneficial effects on PFS in optimally debulked patients.
authors.affiliation: Department of Gynaecological-Oncology, Southampton University Hospitals Trust, Southampton SO16, United Kingdom. simon.crawford@suht.swest.nhs.uk
authors.forename: Simon C
authors.initials: SC
authors.lastname: Crawford
authors.forename: Paul A
authors.initials: PA
authors.lastname: Vasey
authors.forename: Jim
authors.initials: J
authors.lastname: Paul
authors.forename: Andrea
authors.initials: A
authors.lastname: Hay
authors.forename: Jo A
authors.initials: JA
authors.lastname: Davis
authors.forename: Stan B
authors.initials: SB
authors.lastname: Kaye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044362:Australasia; D018394:CA-125 Antigen / Q000097:blood; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008875:Middle Aged; D015999:Multivariate Analysis; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D010052:Ovariectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000145:classification / Q000379:methods*; D016896:Treatment Outcome; D014481:United States
chemical_list: D018394:CA-125 Antigen