Identification of prognostic factors after positive second-look surgery in epithelial ovarian carcinoma.
OBJECTIVE
The objective of this study was to identify independent prognostic factors for survival in patients with epithelial ovarian cancer who had persistent disease identified at second-look surgery.


METHODS
We performed a retrospective chart review of all patients with epithelial ovarian cancer who had positive findings at second-look surgery between June 1991 and June 2002. All patients achieved a complete clinical remission after a prescribed course of primary therapy. Survival was determined from the time of second-look surgery until last follow-up or death.


RESULTS
The study included a total of 262 patients, with a median age of 54 years (range, 22-80). Of the 262 patients, 166 (63%) had died of disease. Records of initial (salvage) treatment after the positive second-look surgery were available for 243 patients. Therapies included the following: intraperitoneal (IP) cisplatin, 71 (29%); IP cisplatin combined with a second drug, 53 (22%); IP therapy other than cisplatin, 29 (12%); intravenous (IV) chemotherapy, 50 (21%); IP and IV therapy, 35 (14%); and oral chemotherapy, 5 (2%). Of the 13 potential prognostic factors analyzed, only 2 factors emerged that, when combined, were significant--residual disease after primary surgery and size of persistent disease found at second-look surgery. Patients with <or=1 cm residual disease after primary surgery and microscopic disease at second-look surgery had significantly improved survival.


CONCLUSIONS
In our analysis, the only prognostic factor for survival in patients with positive second-look procedures was a combination of residual disease after primary surgery and size of persistent disease identified at second-look surgery. No individual chemotherapy treatment imparted a survival advantage. Novel that therapeutic approaches are needed in this setting.
McCreath
Wayne A
WA
Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, MRI-1026, New York, NY 10021, USA.
Eisenhauer
Eric L
EL
Abu-Rustum
Nadeem R
NR
Venkatraman
Ennapadam S
ES
Caceres
Aileen
A
Bier
Rachel
R
Huh
Jae
J
Cho
Jae
J
Barakat
Richard R
RR
Chi
Dennis S
DS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007275:Injections, Intravenous; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D024162:Second-Look Surgery; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D002945:Cisplatin