Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer

Analysis of prognostic factors and survival outcome

Authors

  • Ritu Salani MD,

    Corresponding author
    1. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland
    • The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, 600 North Wolfe Street/Phipps 281, Baltimore, MD 21287
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    • Fax: (410) 614-8718

  • Antonio Santillan MD,

    1. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • Marianna L. Zahurak MS,

    1. Department of Biostatistics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • Robert L. Giuntoli II MD,

    1. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • Ginger J. Gardner MD,

    1. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • Deborah K. Armstrong MD,

    1. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland
    2. Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • Robert E. Bristow MD

    1. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland
    2. Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Abstract

BACKGROUND.

The objective of this study was to evaluate the role of secondary cytoreductive surgery in the outcome of patients who had recurrent epithelial ovarian carcinoma that was limited to ≤5 recurrence sites within the abdomen or pelvis on preoperative imaging studies and attempt to define selection criteria associated with improved survival, with specific attention to the number of lesions suspicious for recurrent disease.

METHODS.

Patients who underwent secondary surgical cytoreduction for recurrent epithelial ovarian cancer between September 1997 and March 2005 were identified retrospectively from tumor registry databases. Study inclusion criteria required a complete clinical response to primary therapy, ≥12 months between initial diagnosis and recurrence, and ≤5 recurrence sites on preoperative imaging studies. Univariate and multivariate logistic regression analyses were used to evaluate the effect of clinicopathologic variables on overall postrecurrence survival.

RESULTS.

Fifty-five patients met the study inclusion criteria. The median patient age at recurrence was 57.7 years, and the median diagnosis-to-recurrence interval was 32 months (range, 12–164 months). Complete cytoreduction was achieved in 41 patients (74.5%). On multivariate analysis, the statistically significant and independent predictors of overall survival were a diagnosis-to-recurrence interval ≥18 months (median survival, 49 months vs 3 months; P < .01), the number of radiographic recurrence sites (median survival, 50 months for patients with 1 or 2 sites vs 12 months for patients with 3 to 5 sites; P < .03), and residual disease (median survival, 50 months for patients with no macroscopic residual disease vs 7.2 months for patients with macroscopic residual disease; P < .01). Age, tumor grade, histology, CA-125 level, ascites, and tumor size were not associated significantly with survival.

CONCLUSIONS.

The current data supported the definition of localized recurrent ovarian cancer as patients with 1 or 2 radiographic recurrence sites. In this select population, a diagnosis-to-recurrence interval ≥18 months and complete secondary surgical cytoreduction, which was achievable in the majority of patients, were associated with a median postrecurrence survival of approximately 50 months. Cancer 2007. © 2007 American Cancer Society.

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