title: Impact of secondary cytoreductive surgery on survival in patients with platinum sensitive recurrent ovarian cancer: analysis of the CALYPSO trial.
abstract: OBJECTIVE
  The role of secondary cytoreductive surgery (SCR) in platinum-sensitive recurrent ovarian cancer (ROC) remains controversial. The overall survival (OS) benefits for surgery reported in observational studies may be due to the selection of patients with better prognosis.
  
  
  METHODS
  Using data from the CALYPSO trial, OS of patients who had SCR was compared to those treated with chemotherapy alone. Multivariate analyses were performed to adjust for prognostic factors. We also tested for an interaction between baseline prognostic groupings and the benefit of surgery.
  
  
  RESULTS
  Of the 975 patients randomised in CALYPSO, 19% had SCR and 80% had chemotherapy alone. OS was longer for the SCR group than for chemotherapy alone (median, 49.9 vs. 29.7 months; adjusted hazard ratio (HR), 0.68; P = 0.004). For patients with SCR, the 3-year OS was 72% for those with no measurable disease, and 28% if residual tumour was larger than 5 cm. Patients with good prognostic features benefited the most from SCR (HR 0.43; P < 0.001). The benefit of SCR was less in patients with poorer prognostic features (test of trend P < 0.001).
  
  
  CONCLUSIONS
  SCR was associated with improved OS in platinum-sensitive ROC, particularly in patients with favourable prognostic characteristics. However, these findings may be due to selection bias, and hence randomised trials are still essential.
authors.affiliation: National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia; Cancer Care Centre, St George Hospital, Grey Street, Kogarah, NSW 2230, Australia. Electronic address: chee.lee@ctc.usyd.edu.au.
authors.forename: Chee Khoon
authors.initials: CK
authors.lastname: Lee
authors.affiliation: National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lord
authors.affiliation: Cancer Care Centre, St George Hospital, Grey Street, Kogarah, NSW 2230, Australia.
authors.forename: Tami
authors.initials: T
authors.lastname: Grunewald
authors.affiliation: National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia.
authors.forename: Val
authors.initials: V
authors.lastname: Gebski
authors.affiliation: Clinique Armoricaine de Radiologie, 21 Rue du Vieux Séminaire, 22015 Saint-Brieuc Cedex, France.
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Hardy-Bessard
authors.affiliation: Department of Gynecology, European Competence Center for Ovarian Cancer, Charité-University Medicine of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Jalid
authors.initials: J
authors.lastname: Sehouli
authors.affiliation: Department of Obstetrics and Gynecology, Haukeland University Hospital, N-5021 Bergen, Norway.
authors.forename: Kathrine
authors.initials: K
authors.lastname: Woie
authors.affiliation: Vancouver Acute Department of Gynaecology, Rm 6207D Diamond Health Care Centre, 2775 Laurel St., Vancouver, BC V5Z 1M9, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Heywood
authors.affiliation: Barmherzige Brüder Graz, Marschallgasse 12, 8020 Graz, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Schauer
authors.affiliation: Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Leuven Cancer Institute, University Hospital Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: Ignace
authors.initials: I
authors.lastname: Vergote
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.affiliation: Academic Department Gynecologic Oncology, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Ferrero
authors.affiliation: Department of Gynecology & Gynecologic Oncology, Klinikum Essen Mitte, Henricistrasse 92, 45136 Essen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Harter
authors.affiliation: Université Paris Descartes, AP-HP, Hôpitaux Universitaires Paris Centre, Site Hôtel-Dieu, Oncologie, 1 Place du Parvis Notre-Dame, 75004 Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Pujade-Lauraine
authors.affiliation: Medical Oncology, Prince of Wales Hospital, Barker Street, Randwick, NSW 2013, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Friedlander
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult
chemical_list: C506643:liposomal doxorubicin; D011092:Polyethylene Glycols; D004317:Doxorubicin; D016190:Carboplatin; D017239:Paclitaxel
keywords: Observational study; Platinum sensitive; Prognosis; Recurrent ovarian cancer; Secondary cytoreductive surgery; Selection bias