Role of secondary cytoreductive surgery in ovarian cancer relapse: who will benefit? A systematic analysis of 240 consecutive patients.
OBJECTIVE
In contrast to primary ovarian cancer, the value of surgery in relapsed-OC (ROC) remains unclear. We evaluated surgical and clinical outcome of secondary cytoreduction in ROC.


METHODS
All consecutive ROC patients who underwent secondary tumor-debulking surgery were systematically analyzed as based on a validated intraoperative documentation tool. Tumor dissemination pattern, operative and clinical outcome were evaluated. Cox-regression analysis was performed to identify independent predictors of mortality.


RESULTS
Between 09/2000 and 10/2008, 240 operations were evaluated; 184 patients (81.1%) were platinum-sensitive and 43 (20%) platinum-resistant. 47.5% of the patients had ascites, while 85.8% presented a multifocal tumor dissemination pattern. In 53.8% a complete tumor resection was achieved; in another 24.2%, postoperative tumor residuals were < 1 cm. In multivariate analysis, no tumor resection (HR: 7.6; 95% CI: 2.9-19.9), ascites > 500 ml (HR: 6.76; 95% CI: 3.77-12.1), platinum resistance (HR: 3.1; 95% CI: 1.26-7.7), and initial FIGO stage IV (HR: 2.86; 95% CI: 1.16-7) were the most significant risk factors for mortality. Median OS was 42.3 months (95% CI: 24.37-60.2); 17.7 months (95% CI: 12.27-23.13); and 7.7 months (95% CI: 3.1-12.3) for patients with complete tumor resection, tumor residuals ≤ 1 and > 1 cm, respectively (trend P-value < 0.001).


CONCLUSIONS
Absence of ascites, platinum-sensitivity, initial FIGO stage < IV, and complete tumor resection correlate with a significantly better long-term prognosis after ROC surgery. However, a significant trend of continuously improving survival associated with increasing tumor reduction rates could be identified even in patients where a complete tumor resection is not achievable.
Sehouli
Jalid
J
Department of Gynecology, Charité University Medical Center Berlin, Berlin, Germany. sehouli@aol.com
Richter
R
R
Braicu
Elena Ioana
EI
Bühling
Kai J
KJ
Bahra
Marcus
M
Neuhaus
Peter
P
Lichtenegger
Werner
W
Fotopoulou
Christina
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018365:Neoplasm, Residual / Q000473:pathology; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017671:Platinum Compounds / Q000494:pharmacology; D011379:Prognosis; D016896:Treatment Outcome
D017671:Platinum Compounds