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Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: A combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials
Author(s) -
du Bois Andreas,
Reuss Alexander,
PujadeLauraine Eric,
Harter Philipp,
RayCoquard Isabelle,
Pfisterer Jacobus
Publication year - 2009
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24149
Subject(s) - medicine , taxane , debulking , oncology , ovarian cancer , stage (stratigraphy) , chemotherapy , multivariate analysis , randomized controlled trial , cancer , tumor debulking , surgery , breast cancer , paleontology , biology
Abstract BACKGROUND: Primary surgery followed by platinum‐taxane based chemotherapy has been the standard therapy in advanced ovarian cancer. However, the prognostic role of complete and so‐called optimal and suboptimal debulking and its interaction with biological factors has not been not fully defined. METHODS: Exploratory analysis was conducted of 3 prospective randomized trials (AGO‐OVAR 3, 5, and 7) investigating platinum‐taxane based chemotherapy regimens in advanced ovarian cancer conducted between 1995 and 2002. RESULTS: A total of 3126 patients were analyzed. Approximately one‐third each fulfilled criteria for complete resection (group A), small residual tumor burden of 1‐10 mm (group B), or macroscopic residual disease exceeding 1 cm in diameter (group C). Multivariate analysis showed improved progression‐free and overall survival for group A with complete resection compared with groups B or C ( P < .0001). The impact of so‐called optimal debulking as in group B showed a smaller prognostic impact compared with group C. Further independent prognostic factors for overall survival were age, performance status, grade, FIGO stage, and histology, namely the mucinous subtype. An interaction between residual tumor and some biologic factors was demonstrated. CONCLUSIONS: The goal of primary surgery should be complete resection. The prognostic impact of tumor biology seemed to be partially overruled by residual tumor and further evaluation of biologic factors should stratify for residual tumor. Cancer 2009. © 2009 American Cancer Society.