title: The Value of Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer and Application of a Prognostic Score.
abstract: OBJECTIVE
  Secondary cytoreductive surgery (SCS) is an option for treating patients with recurrent ovarian cancer. Three ongoing randomized trials are comparing SCS plus chemotherapy with chemotherapy alone, and few comparative studies have been published.
  
  
  METHODS
  We performed a retrospective review of data on 209 patients with recurrent ovarian carcinoma who were treated at a single institution from 2000 to 2013. We analyzed prognostic factors in the recurrence setting to determine the value of SCS in a multivariate model, including propensity score, by prognostic group.
  
  
  RESULTS
  In the univariate analysis, younger than 65 years, personal or family history of breast or ovarian cancer, stage I-II at diagnosis, residual disease 10 mm or less after primary debulking surgery, performance status 1 or less, CA125 less than 100, only 1 metastatic site of recurrence, platinum-free interval of more than 12 months, and SCS correlated with better overall survival. In the multivariate model, including propensity score, SCS remained associated with a 66% decrease in the risk of death (hazard ratio, 0.34; 95% CI, 0.15-0.76, P = 0.008). Secondary cytoreductive surgery was also linked to longer progression-free survival (hazard ratio, 0.50; 95% CI, 0.30-0.84, P = 0.008). There was no evidence of a benefit of SCS in patients with unfavorable prognosis (P for interaction = 0.654).
  
  
  CONCLUSIONS
  Our results confirm the benefit of SCS in progression-free survival and overall survival in the recurrent setting and suggest that it exists not only for patients with a good prognosis.
authors.affiliation: *Medical Oncology Department, †Gynecology Oncology Department, and ‡Oncogenetics Department, AC Camargo Cancer Center, Sao Paulo, SP, Brazil.
authors.forename: Alexandre Andre Balieiro Anastacio
authors.initials: AA
authors.lastname: da Costa
authors.forename: Camila V
authors.initials: CV
authors.lastname: Valadares
authors.forename: Henrique
authors.initials: H
authors.lastname: Mantoan
authors.forename: Augusto
authors.initials: A
authors.lastname: Saito
authors.forename: Marcella Marinelli
authors.initials: MM
authors.lastname: Salvadori
authors.forename: Andreia Paiva
authors.initials: AP
authors.lastname: Guimarães
authors.forename: Solange Moraes
authors.initials: SM
authors.lastname: Sanches
authors.forename: Maria Isabel Alves de Souza Wadington
authors.initials: MI
authors.lastname: Achatz
authors.forename: Glauco
authors.initials: G
authors.lastname: Baiocchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate