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Role of secondary cytoreductive surgery in ovarian cancer relapse: Who will benefit? A systematic analysis of 240 consecutive patients
Author(s) -
Sehouli Jalid,
Richter R.,
Braicu Elena Ioana,
Bühling Kai J.,
Bahra Marcus,
Neuhaus Peter,
Lichtenegger Werner,
Fotopoulou Christina
Publication year - 2010
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21652
Subject(s) - medicine , debulking , ascites , ovarian cancer , surgery , multivariate analysis , stage (stratigraphy) , tumor debulking , cancer , oncology , chemotherapy , paleontology , biology
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