title: Potential survival benefit of secondary cytoreductive surgery for recurrent epithelial ovarian, tubal, and peritoneal cancers.
abstract: OBJECTIVE
  Although treatment for recurrent epithelial ovarian, tubal, and peritoneal cancers is usually not curative and intends to be palliative, a certain significance of secondary cytoreductive surgery (SCS) for recurrent tumor has been reported; still, there are limitations in this strategy including difficulty in predicting successful complete resection and selecting good candidates. The purpose of this study was to explore the potential survival benefit of SCS in patients with recurrent epithelial ovarian, tubal, and peritoneal cancers.
  
  
  METHODS
  Among all patients who underwent primary therapy for epithelial ovarian, tubal, and peritoneal cancers between 1994 and 2006 at our institute, medical records of patients who were submitted to SCS for recurrence following complete remission after primary therapy were retrospectively investigated. Kaplan-Meier method and log-rank test were used for survival analysis, and Cox proportional hazard regression model was used for quantifying the relations between survival and covariates.
  
  
  RESULTS
  Thirty-four patients met the inclusion criteria. Complete resection of all visible tumors at SCS was achieved in 24 of patients (75%). Median postrecurrence survival was 60 months. On univariate analysis, solitary recurrence, disease-free interval, CA125 value at recurrence, and complete resection were significant prognostic factors on postrecurrence survival; whereas on multivariate analysis, CA125 value at recurrence and complete resection were independent prognostic factors. In addition, a comparison according to the initial method that detected recurrence revealed that patients whose recurrence was detected with CA125 elevations had significantly worse postrecurrence survival than those detected with routine examinations including image scans (P = 0.021).
  
  
  CONCLUSIONS
  In the present study, the impact of SCS on the significant survival benefit was identified for patients with low CA125 value at recurrence as well as with complete resection. Although further analyses are needed, patients whose recurrence was diagnosed by routine examinations without CA125 elevation might be better candidates for SCS.
authors.affiliation: Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Saitama, Japan. tgoto@ndmc.ac.jp
authors.forename: Tomoko
authors.initials: T
authors.lastname: Goto
authors.forename: Masashi
authors.initials: M
authors.lastname: Takano
authors.forename: Akio
authors.initials: A
authors.lastname: Watanabe
authors.forename: Morikazu
authors.initials: M
authors.lastname: Miyamoto
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kato
authors.forename: Junko
authors.initials: J
authors.lastname: Hirata
authors.forename: Hidenori
authors.initials: H
authors.lastname: Sasa
authors.forename: Kenichi
authors.initials: K
authors.lastname: Furuya
mesh_terms: D000368:Aged; D018394:CA-125 Antigen / Q000097:blood; D005185:Fallopian Tube Neoplasms / Q000097:blood / Q000601:surgery*; D005260:Female; D006801:Humans; D008565:Membrane Proteins / Q000097:blood; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000601:surgery*; D009375:Neoplasms, Glandular and Epithelial / Q000097:blood / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000097:blood / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000097:blood / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D018394:CA-125 Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins