title: Individualized Treatment of Patients With Early-Stage Epithelial Ovarian Cancer After Incomplete Initial Surgery.
abstract: OBJECTIVE
  Incomplete initial surgery complicates subsequent management of early-stage epithelial ovarian carcinoma (ESEOC). This study aimed to determine the most appropriate strategies for individualized treatment of these patients.
  
  
  METHODS
  Medical records of ESEOC patients treated at our hospital between 2000 and 2011 were reviewed, and 246 patients initially treated by incomplete surgery were included. A scoring system was established to assess the quality of initial surgery (QOIS).
  
  
  RESULTS
  Of 246 patients, 130 underwent restaging surgery and 116 received chemotherapy only. Follow-up duration ranged from 4 to 148 months (median, 72 months). The 5-year overall survival (OS) rates were 87.5% and 74.7% in the restaging and chemotherapy groups, respectively. Survival analysis showed significantly better recurrence-free survival (RFS) and OS in the restaging group (P = 0.043 and P = 0.029, respectively). Multivariate analysis showed that histologic grade was an independent predictor for RFS and OS in the restaging group (P = 0.035 and P = 0.038, respectively), and histologic grade (P = 0.005 and P = 0.015, respectively) and QOIS (P = 0.044 and P = 0.024, respectively) were independent predictors for RFS and OS in the chemotherapy group. Subgroup analysis showed that restaging surgery produced better RFS and OS than chemotherapy in patients with low QOIS and unfavorable histology (5-year RFS, 58.5% vs 33.4%, P = 0.007; 5-year OS, 82.2% vs 54.4%, P = 0.011), whereas the outcomes between the treatment options were comparable in patients with high QOIS or favorable histology.
  
  
  CONCLUSIONS
  Our results support individualized treatment of ESEOC patients initially treated by incomplete surgery. Restaging surgery is recommended only for patients with low QOIS and unfavorable histology.
authors.affiliation: Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Tu
authors.forename: Ying
authors.initials: Y
authors.lastname: Xiong
authors.forename: He
authors.initials: H
authors.lastname: Huang
authors.forename: Yongwen
authors.initials: Y
authors.lastname: Huang
authors.forename: Ting
authors.initials: T
authors.lastname: Wan
authors.forename: Ting
authors.initials: T
authors.lastname: Deng
authors.forename: Jihong
authors.initials: J
authors.lastname: Liu
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D057285:Precision Medicine; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult