title: Prognostic value of residual tumor size in patients with epithelial ovarian cancer FIGO stages IIA-IV: analysis of the OVCAD data.
abstract: OBJECTIVE
  The objective of the study was to evaluate the prognostic impact of residual tumor size after cytoreductive surgery in patients with epithelial ovarian cancer.
  
  
  METHODS
  In this prospective, multicenter study, 226 patients with epithelial ovarian cancer (International Federation of Gynecology and Obstetrics stages IIA-IV) were included. Patients were treated with cytoreductive surgery and adjuvant platinum-based chemotherapy. Univariate and multivariable survival analyses were performed to investigate the impact of residual tumor size on progression-free and overall survival.
  
  
  RESULTS
  In 69.4% of patients, surgery resulted in complete tumor resection; minimal residual disease (≤1 cm) was achieved in 87.2% of patients. Advanced tumor stage was associated with a lower rate of complete tumor resection (P < 0.001). After cytoreductive surgery, 3-year overall survival rates were 72.4%, 65.8%, and 45.2% for patients without, with minimal, and with gross residual disease (>1 cm), respectively (P < 0.001). Multivariable survival analysis revealed residual tumor size (P = 0.04) and older patient age (P = 0.02) as independent prognosticators for impaired overall survival. Complete cytoreduction was predictive for a higher rate of treatment response (P = 0.001) and was associated with prolonged progression-free and overall survival (P < 0.001 and P = 0.001).
  
  
  CONCLUSIONS
  The size of residual disease after cytoreduction is one of the most crucial prognostic factors for patients with ovarian cancer. Patients after complete cytoreduction have a superior outcome compared with patients with residual disease. Leaving no residual tumor has to be the aim of primary surgery for ovarian cancer; therefore, patients should receive treatment at centers able to undertake complex cytoreductive procedures.
authors.affiliation: Division General Gynaecology and Gynaecological Oncology, Department of Obstetrics and Gynaecology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria. stephan.polterauer@meduniwien.ac.at
authors.forename: Stephan
authors.initials: S
authors.lastname: Polterauer
authors.forename: Ignace
authors.initials: I
authors.lastname: Vergote
authors.forename: Nicole
authors.initials: N
authors.lastname: Concin
authors.forename: Ioana
authors.initials: I
authors.lastname: Braicu
authors.forename: Radoslav
authors.initials: R
authors.lastname: Chekerov
authors.forename: Sven
authors.initials: S
authors.lastname: Mahner
authors.forename: Linn
authors.initials: L
authors.lastname: Woelber
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cadron
authors.forename: Toon
authors.initials: T
authors.lastname: Van Gorp
authors.forename: Robert
authors.initials: R
authors.lastname: Zeillinger
authors.forename: Dan Cacsire
authors.initials: DC
authors.lastname: Castillo-Tong
authors.forename: Jalid
authors.initials: J
authors.lastname: Sehouli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D018365:Neoplasm, Residual; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden / Q000502:physiology*