Role of secondary cytoreductive surgery in ovarian cancer relapse: Who will benefit? A systematic analysis of 240 consecutive patients

Authors


  • The authors declare that there are no conflicts of interest.

Abstract

Background and Objectives

In contrast to primary ovarian cancer, the value of surgery in relapsed-OC (ROC) remains unclear. We evaluated surgical and clinical outcome of secondary cytoreduction in ROC.

Methods

All consecutive ROC patients who underwent secondary tumor-debulking surgery were systematically analyzed as based on a validated intraoperative documentation tool. Tumor dissemination pattern, operative and clinical outcome were evaluated. Cox-regression analysis was performed to identify independent predictors of mortality.

Results

Between 09/2000 and 10/2008, 240 operations were evaluated; 184 patients (81.1%) were platinum-sensitive and 43 (20%) platinum-resistant. 47.5% of the patients had ascites, while 85.8% presented a multifocal tumor dissemination pattern. In 53.8% a complete tumor resection was achieved; in another 24.2%, postoperative tumor residuals were <1 cm. In multivariate analysis, no tumor resection (HR: 7.6; 95% CI: 2.9–19.9), ascites >500 ml (HR: 6.76; 95% CI: 3.77–12.1), platinum resistance (HR: 3.1; 95% CI: 1.26–7.7), and initial FIGO stage IV (HR: 2.86; 95% CI: 1.16–7) were the most significant risk factors for mortality. Median OS was 42.3 months (95% CI: 24.37–60.2); 17.7 months (95% CI: 12.27–23.13); and 7.7 months (95% CI: 3.1–12.3) for patients with complete tumor resection, tumor residuals ≤1 and >1 cm, respectively (trend P-value <0.001).

Conclusions

Absence of ascites, platinum-sensitivity, initial FIGO stage <IV, and complete tumor resection correlate with a significantly better long-term prognosis after ROC surgery. However, a significant trend of continuously improving survival associated with increasing tumor reduction rates could be identified even in patients where a complete tumor resection is not achievable. J. Surg. Oncol. 2010;102:656–662. © 2010 Wiley-Liss, Inc.

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