Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial.
BACKGROUND
The role of cytoreductive surgery in relapsed ovarian cancer is not clearly defined. Therefore, patient selection remains arbitrary and depends on the center's preference rather than on established selection criteria. The Descriptive Evaluation of preoperative Selection KriTeria for OPerability in recurrent OVARian cancer (DESKTOP OVAR) trial was undertaken to form a hypothesis for a panel of criteria for selecting patients who might benefit from surgery in relapsed ovarian cancer.


METHODS
The DESKTOP trial was an exploratory study based on data from a retrospective analysis of hospital records. Twenty-five member institutions of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee (AGO OC) and AGO-OVAR boards collected data on their patients with cytoreductive surgery for relapsed invasive epithelial ovarian cancer performed in 2000-2003.


RESULTS
Two hundred and sixty-seven patients were included. Complete resection was associated with significantly longer survival compared with surgery leaving any postoperative residuals [median 45.2 vs. 19.7 months; hazard ratio (HR) 3.71; 95% confidence interval (CI) 2.27-6.05; P < .0001]. Variables associated with complete resection were performance status (PS) [Eastern Cooperative Oncology Group (ECOG) 0 vs. > 0; P < .001], International Federation of Gynecology and Obstetrics (FIGO) stage at initial diagnosis (FIGO I/II vs. III/IV, P = .036), residual tumor after primary surgery (none vs. present, P <.001), and absence of ascites > 500 ml (P < .001). A combination of PS, early FIGO stage initially or no residual tumor after first surgery, and absence of ascites could predict complete resection in 79% of patients.


CONCLUSIONS
Only complete resection was associated with prolonged survival in recurrent ovarian cancer. The identified criteria panel will be verified in a prospective trial (AGO-DESKTOP II) evaluating whether it will render a useful tool for selecting the right patients for cytoreductive surgery in recurrent ovarian cancer.
Harter
Philipp
P
Department of Gynecology & Gynecologic Oncology, HSK, Dr. Horst Schmidt Klinik Wiesbaden, Ludwig-Erhard-Strasse 100, Wiesbaden, D-65199, Germany. p.harter@gmx.de
du Bois
Andreas
A
Hahmann
Maik
M
Hasenburg
Annette
A
Burges
Alexander
A
Loibl
Sibylle
S
Gropp
Martina
M
Huober
Jens
J
Fink
Daniel
D
Schröder
Willibald
W
Muenstedt
Karsten
K
Schmalfeldt
Barbara
B
Emons
Guenter
G
Pfisterer
Jacobus
J
Wollschlaeger
Kerstin
K
Meerpohl
Hans-Gerd
HG
Breitbach
Georg-Peter
GP
Tanner
Berno
B
Sehouli
Jalid
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000401:mortality*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000601:surgery; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate