title: Ovarian cancer: sites of recurrence.
abstract: BACKGROUND
  Improved knowledge of recurrence sites after contemporary surgical management of ovarian cancer is needed.
  
  
  METHODS
  We retrospectively reviewed consecutive patients managed for epithelial ovarian or tubal cancer with surgery and platinum-based chemotherapy between January 1, 2005, and December 31, 2009, in a tertiary teaching hospital. The site of first recurrence was recorded. Univariate analysis was performed to identify factors associated with site-specific recurrence. Overall survival and progression-free survival were computed using the Kaplan-Meier method, and log-rank tests were performed to assess the impact on survival of the variables of interest.
  
  
  RESULTS
  Recurrences were noted in 3 (20%) of 15 International Federation of Gynecologists and Obstetricians stage I to IIa patients and 36 (62.1%) of 58 International Federation of Gynecologists and Obstetricians IIb to IV patients, and the median progression-free survival was 21.6 (2.5-71) and 19.3 (1.8-67.6) months, respectively. In the advanced-disease group, 75% of recurrences involved the peritoneum and 40% were confined to the peritoneum; peritoneal recurrences developed at both treated and untreated sites. Peritoneal recurrence was associated with greater initial peritoneal involvement (Sugarbaker score, 12.1 ± 8.2 vs 7.1 ± 7.4; P = 0.01) and residual postoperative tumor. Nodal recurrences were noted in 38% of all recurrences, usually in combination with peritoneal recurrence and in the abdominal territories. Isolated distant metastasis was a rare mode of recurrence (8%).
  
  
  CONCLUSIONS
  The peritoneum is the main recurrence site in both early and advanced ovarian cancer. Initial disease spread and extent of surgery are associated with the recurrence risk. This article supports the view that more attention should be directed toward extensive treatment of the peritoneum.
authors.affiliation: *Service de Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France; †Service de Gynécologie & Obstétrique, CHI Poissy-St-Germain, Poissy, France; ‡Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; §Service d'Oncologie Médicale, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France; ∥Service d'Anatamopathologie, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France; ¶INSERM UMR-S 747, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; and #Equipe d'accueil EA 7285 "Risques, cliniques et sécurité en santé des femmes et en sante périnatale," Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Amate
authors.forename: Cyrille
authors.initials: C
authors.lastname: Huchon
authors.forename: Anne Lucie
authors.initials: AL
authors.lastname: Dessapt
authors.forename: Chérazade
authors.initials: C
authors.lastname: Bensaid
authors.forename: Jacques
authors.initials: J
authors.lastname: Medioni
authors.forename: Marie-Aude
authors.initials: MA
authors.lastname: Le Frère Belda
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Bats
authors.forename: Fabrice R
authors.initials: FR
authors.lastname: Lécuru
mesh_terms: D000368:Aged; D018284:Cystadenocarcinoma, Serous / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D018365:Neoplasm, Residual; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome