title: Are Early Relapses in Advanced-Stage Ovarian Cancer Doomed to a Poor Prognosis?
abstract: OBJECTIVE
  Early recurrence (ER) after completion of therapeutic regimen in advanced-stage ovarian cancer is a challenging clinical situation. Patients are perceived as invariably having a poor prognosis. We investigated the possibility of defining different prognostic subgroups and the parameters implicated in prognosis of ER patients.
  
  
  METHODS
  We analyzed a multi-centric database of 527 FIGO stage IIIC and IV ovarian cancer patients. We defined patients relapsing within 12 months as ER and investigated using Cox logistic regression the prognostic factors in ER group. We subsequently divided ER patients into good and poor prognosis groups according to a lower or higher overall survival (OS) at 12 months after relapse and determined parameters associated to poor prognosis.
  
  
  RESULTS
  The median follow up was 49 months. One hundred and thirty eight patients recurred within 12 months. OS and Disease Free Survival (DFS) were 24.6 and 8.6 months, respectively, in this group of patients. Among the ER patients, 73 had a poor prognosis with an OS after relapse below 12 months (mean OS = 5.2 months) and 65 survived after one year (mean OS = 26.9 months). Residual disease (RD) after debulking surgery and mucinous histological subtype negatively impacted prognosis (HR = 1.758, p = 0.017 and HR = 8.641, p = 0.001 respectively). The relative risk of death within 12 months following relapse in ER patients was 1.61 according to RD status. However, RD did not affect DFS (HR = 0.889, p = 0.5).
  
  
  CONCLUSIONS
  ER in advanced-stage ovarian cancer does not inevitably portend a short-term poor prognosis. RD status after initial cytoreduction strongly modulates OS, that gives additional support to the concept of maximum surgical effort even in patients who will experience early recurrence. The heterogeneity in outcomes within the ER group suggests a role for tumor biology in addition to classical clinical parameters.
authors.affiliation: Stem cell and microenvironment laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar.|Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, United States of America.|Department of Gynecologic Surgery, Toulouse Academic Hospital, F-31059, Toulouse, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Vidal
authors.affiliation: Department of Gynecologic Surgery, Toulouse Academic Hospital, F-31059, Toulouse, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Guerby
authors.affiliation: Department of Gynecologic Surgery, Saint Luc Academic Hospital, Catholic University of Louvain, Bruxelles, Belgium.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Luyckx
authors.affiliation: Biostatistics Core, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar.
authors.forename: Pascale
authors.initials: P
authors.lastname: Haddad
authors.affiliation: Department of Surgery, Institut Bergonie, Comprehensive Cancer Center, Bordeaux, France.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Stoeckle
authors.affiliation: Department of Gynecologic Surgery, Institut Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.affiliation: Department of Gynecologic Oncology, Centre Oscar Lambret, F-59037, Lille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Leblanc
authors.affiliation: Department of Gynecologic Oncology, Georges Pompidou European Hospital, Paris, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Lecuru
authors.affiliation: Department of Gynecologic Surgery, Tenon Hospital, Paris, France.
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
authors.affiliation: Department of Surgical Oncology, Centre Gauducheau, Comprehensive Cancer Center, Saint Herblain, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Classe
authors.affiliation: Department of Surgical Oncology, Jean Perrin Cancer Center, Clermont-Ferrand, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Pomel
authors.affiliation: Department of Surgical Oncology, Institut Claudius Regaud, Comprehensive Cancer Center, F-31052 Toulouse, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Filleron
authors.affiliation: Department of Surgical Oncology, Institut Claudius Regaud, Comprehensive Cancer Center, F-31052 Toulouse, France.
authors.forename: Gwenael
authors.initials: G
authors.lastname: Ferron
authors.affiliation: Department of Surgery, Institut Bergonie, Comprehensive Cancer Center, Bordeaux, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Querleu
authors.affiliation: Stem cell and microenvironment laboratory, Weill Cornell Medical College in Qatar, Education City, Qatar Foundation, Doha, Qatar.|Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Arash
authors.initials: A
authors.lastname: Rafii
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000401:mortality / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome
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