title: Prognostic impact of debulking surgery and residual tumor in patients with epithelial ovarian cancer FIGO stage IV.
abstract: OBJECTIVE
  To determine the impact of debulking surgery (DS) and residual disease (RD) on outcome in patients with FIGO stage IV epithelial ovarian cancer (EOC).
  
  
  METHODS
  This exploratory study included 326 consecutive patients with FIGO IV EOC treated in our centers from 2000 to 2014. Data were extracted from our prospectively maintained registry.
  
  
  RESULTS
  In patients, who underwent DS (n=286; 87.7%), complete macroscopic resection was achieved in 54.9% (RD0; n=157), RD of 1-10mm in 30.8% (RD1-10; n=88), and RD of >10mm in 14.3% (RD>10, n=41). Forty patients without surgery (NoCS; 12.3%) underwent either primary chemotherapy or palliative care only. Median overall survival (OS) in NoCS was 19months compared to 16, 25, and 50months in RD>10, RD1-10, and RD0, respectively (p<0.001). Multivariate analysis confirmed an inferior OS for NoCS (HR 2.51, 95% CI 1.25-3.57; p=0.001), RD>10 (HR 2.17, 95% CI 1.43-3.70; p=0.002), and RD1-10 (HR 1.50, 95% CI 1.01-2.23; p=0.046) when compared with RD0. Additional independent prognostic factors were poor performance status, ascites >500mL, and advanced intraabdominal tumor stage.
  
  
  CONCLUSIONS
  Our results confirm the prognostic impact of optimal DS in FIGO stage IV disease. Survival benefit was greatest for patients with complete resection. Although not to the same extent patients do benefit from DS with RD≤10mm. Of note, patients with RD>10mm after DS seemed not to profit from surgery showing comparable OS to patients without DS. Selecting patients who benefit from DS is as crucial in stage IV EOC patients as it is in any other patients with advanced EOC.
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany. Electronic address: b.ataseven@kliniken-essen-mitte.de.
authors.forename: Beyhan
authors.initials: B
authors.lastname: Ataseven
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany; Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Grimm
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Harter
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Heitz
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Traut
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany.
authors.forename: Sonia
authors.initials: S
authors.lastname: Prader
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: du Bois
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Debulking surgery; FIGO IV ovarian cancer; Overall survival; Residual tumor