Disease extent at secondary cytoreductive surgery is predictive of progression-free and overall survival in advanced stage ovarian cancer: An NRG Oncology/Gynecologic Oncology Group study.
OBJECTIVE
GOG 152 was a randomized trial of secondary cytoreductive surgery (SCS) in patients with suboptimal residual disease (residual tumor nodule >1cm in greatest diameter) following primary cytoreductive surgery for advanced stage ovarian cancer. The current analysis was undertaken to evaluate the impact of disease findings at SCS on progression-free survival (PFS) and overall survival (OS).


METHODS
Among the 550 patients enrolled on GOG-152, two-hundred-sixteen patients were randomly assigned following 3cycles of cisplatin and paclitaxel to receive SCS. In 15 patients (7%) surgery was declined or contraindicated. In the remaining 201 patients the operative and pathology reports were utilized to classify their disease status at the beginning of SCS as; no gross disease/microscopically negative N=40 (19.9%), no gross disease/microscopically positive N=8 (4.0%), and gross disease N=153 (76.1%).


RESULTS
The median PFS for patients with no gross disease/microscopically negative was 16.1months, no gross disease/microscopically positive was 13.5months and for gross disease was 11.7months, P=0.002. The median OS for patients with no gross disease/microscopically negative was 51.5months, no gross disease/microscopically positive was 42.6months and for gross disease was 34.9months, P=0.018.


CONCLUSIONS
Although as previously reported SCS did not change PFS or OS, for those who underwent the procedure, their operative and pathologic findings were predictive of PFS and OS. Surgical/pathological residual disease is a biomarker of response to chemotherapy and predictive of PFS and OS.
Dept. of OB/GYN, Cleveland Clinic, Cleveland, OH 44109, United States. Electronic address: rosep@ccf.org.
Peter G
PG
Rose
NRG Oncology Statistics & Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States. Electronic address: james.j.java@gmail.org.
James J
JJ
Java
Dept. of OB/GYN, University of Pennsylvania Hospital System, University of Pennsylvania, Philadelphia, PA 19104, United States. Electronic address: mark.a.morgan@uphs.upenn.edu.
Mark A
MA
Morgan
Division of Gynecologic Oncology, Dept. of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC 27710, United States. Electronic address: secor002@mc.duke.edu.
Angeles
A
Alvarez-Secord
Dept. of GYN/Oncology, Hershey Medical Center, Hershey, PA 17033, United States. Electronic address: jkesterson@hmc.psu.edu.
Joshua P
JP
Kesterson
Section of Gyn Onc, Simon Cancer Center, Indianapolis, IN 46202, United States. Electronic address: fstehman@iupui.edu.
Frederick B
FB
Stehman
Division of Gynecologic Oncology, Cooper Health, Camden, NJ 08103, United States. Electronic address: warshal-david@cooperhealth.edu.
David P
DP
Warshal
Dept. of Obstetrics & Gynecology, Medical University of South Carolina, Charleston, SC 29425, United States. Electronic address: creasman@musc.edu.
William T
WT
Creasman
Hanjani Institute for Gynecologic Oncology, Abington Memorial Hospital, Abington, PA 19001, United States. Electronic address: phanjani@amh.org.
Parviz
P
Hanjani
Dept. of Oncology, Wayne State University Medical Center, Detroit, MI 48201, United States. Electronic address: rmorris@med.wayne.edu.
Robert T
RT
Morris
Dept. of Gynecologic Oncology, Ohio State University Medical Center, Columbus, OH 43210, United States. Electronic address: larry.copeland@osumc.edu.
Larry J
LJ
Copeland
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018269:Carcinoma, Endometrioid / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D065426:Cytoreduction Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000473:pathology* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery; D017239:Paclitaxel / Q000008:administration & dosage; D011379:Prognosis; D012086:Reoperation; D015996:Survival Rate
D017239:Paclitaxel; D002945:Cisplatin
Pathologic complete response; Secondary cytoreduction
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