Prognostic and predictive value of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) score in surgery for recurrent ovarian cancer.
OBJECTIVE
The Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) score was developed as selection criteria and validated as predictor of a high probability for complete resection in recurrent ovarian cancer. It is not defined whether the predictive value is independent from underlying tumor biology or is solely based on a selection of good prognostic risks.


METHODS
We performed an exploratory analysis of all consecutive patients with cytoreductive surgery in recurrent ovarian cancer in a tertiary referral center 1999-2013, before and after introduction of the AGO score.


RESULTS
217 consecutive patients were included of whom 112 patients were AGO score positive and 105 patients were score negative. Corresponding complete resection rates were 89.3% and 66.7%, respectively, and confirm the score's predictive value. However, a positive AGO score was also associated with better outcome after adjustment for surgical outcome. Patients with complete resection and a positive AGO score showed a median overall survival of 63.9 months (95% CI 48.1-79.6) compared to 48.4 months (95% CI 30.3-66.5) after complete resection and negative score (log-rank p=0.10). However, in multivariate analysis the only independent prognostic factor was complete resection (HR 2.450; 95% CI: 1.542-3.891).


CONCLUSIONS
The AGO score could identify suitable candidates for secondary cytoreductive surgery but failed to prove an independent prognostic value thus suggesting an effect of successful surgery on its own. However, the latter has to be proven prospectively. In addition, further studies should evaluate the predictive and prognostic impact of a negative score.
Dept. of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany; Dept. of Gynecology & Gynecologic Oncology, HSK, Dr. Horst Schmidt Klinik, Wiesbaden, Germany. Electronic address: p.harter@gmx.de.
Philipp
P
Harter
Dept. of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany; Dept. of Gynecology & Gynecologic Oncology, HSK, Dr. Horst Schmidt Klinik, Wiesbaden, Germany.
Bianca
B
Beutel
Dept. of General & Visceral Surgery, Kliniken Essen-Mitte, Essen, Germany.
Piero F
PF
Alesina
Dept. of General & Visceral Surgery, HSK, Dr. Horst Schmidt Klinik, Wiesbaden, Germany.
Dietmar
D
Lorenz
Dept. of Anesthesiology and Intensive Care, Kliniken Essen-Mitte, Essen, Germany.
Andre
A
Boergers
Dept. of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany; Dept. of Gynecology & Gynecologic Oncology, HSK, Dr. Horst Schmidt Klinik, Wiesbaden, Germany.
Florian
F
Heitz
Dept. of Gynecology & Gynecologic Oncology, HSK, Dr. Horst Schmidt Klinik, Wiesbaden, Germany.
Rita
R
Hils
Dept. of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany.
Christian
C
Kurzeder
Dept. of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany; Dept. of Gynecology & Gynecologic Oncology, HSK, Dr. Horst Schmidt Klinik, Wiesbaden, Germany.
Alexander
A
Traut
Dept. of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany; Dept. of Gynecology & Gynecologic Oncology, HSK, Dr. Horst Schmidt Klinik, Wiesbaden, Germany.
Andreas
A
du Bois
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D055815:Young Adult
AGO score; Cytoreductive surgery; Ovarian cancer; Relapse