title: Performance of AGO score for secondary cytoreduction in a high-volume U.S. center.
abstract: OBJECTIVE
  Determine the predictive value of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) score, and prognostic factors for survival, in patients undergoing secondary cytoreductive surgery (SCS) for recurrent ovarian cancer in a high-volume U.S. center.
  
  
  METHODS
  Medical records of women undergoing SCS between 12/1/1998 and 12/31/2013 were reviewed. Women with no gross residual disease (RD0) at primary surgery, ECOG performance status (PS) ≤1 at recurrence, and no ascites on CT at recurrence were classified as AGO score positive. Women with incomplete information to determine the AGO score were excluded. Overall survival (OS) and progression-free survival (PFS) following SCS, respectively, were estimated from multivariable Cox proportional hazards models.
  
  
  RESULTS
  192 women met inclusion criteria. Median disease-free interval (DFI) was 1.9years (IQR, 1.0-3.5). Of the 102 (53.1%) AGO score positive cases, 84.3% (95% CI, 77.3-91.4%) achieved RD0 at SCS. However, 64.4% of AGO score negative cases also reached RD0. Patients with RD0 after SCS survived longer (median OS, 5.4years) vs. RD ≤1cm (2.4years) vs. RD >1cm (1.3years) (p<0.001). Median PFS was also longer in patients with RD0 (1.5years) vs. RD ≤1cm (0.9years) vs. RD >1cm (1.0years) (p=0.001). Among those with RD0 at SCS, AGO score was not associated with survival benefit, however, number of disease sites at recurrence, ECOG PS at recurrence, and DFI were associated with OS and PFS.
  
  
  CONCLUSIONS
  AGO score can identify patients with a high likelihood of complete secondary cytoreduction and improved survival. However, most AGO score negative cases were also completed resected at SCS. Additional refinement of the score is needed to exclude women from SCS.
authors.affiliation: Division of Gynecologic Oncology, Scripps Clinic, La Jolla, CA, United States.
authors.forename: Jo Marie Tran
authors.initials: JM
authors.lastname: Janco
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Amanika
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Division of Biomedical Statistics, Mayo Clinic, Rochester, MN, United States.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.affiliation: Division of Biomedical Statistics, Mayo Clinic, Rochester, MN, United States.
authors.forename: Michaela E
authors.initials: ME
authors.lastname: McGree
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States. Electronic address: cliby.william@mayo.edu.
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
mesh_terms: D000368:Aged; D065426:Cytoreduction Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010051:Ovarian Neoplasms / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies
keywords: Recurrent ovarian cancer; Secondary cytoreduction