Effect of cytoreductive surgery on survival of patients with recurrent epithelial ovarian cancer

BACKGROUND AND OBJECTIVES: The value of secondary cytoreductive surgery is still controversial, especially in patients with recurrent epithelial ovarian cancer. In this retrospective study, we investigated the effect on survival of secondary cytoreduction for recurrent disease and variables influencing redebulking surgical outcome. METHODS: Between 1986 and 1997, 60 patients who received primary cytoreductive surgery and platinum-based chemotherapy for stage III and IV epithelial ovarian cancer experienced disease recurrence at least 6 months after completion of primary therapy, and secondary surgical cytoreduction was performed. The optimal residual disease cutoff was 1.0 cm. The Cox proportional regression model and Logistic stepwise regression were used in statistical processing of the data. RESULTS: The median progression-free interval between the two operations was 13 months (range, 6-56 months). Optimal secondary cytoreduction was achieved in 23 patients (38.33%). There was a significant difference in survival between patients who were optimally cytoreduced compared to those suboptimally cytoreduced, with an estimated median survival in the optimal group of 19 months vs. 8 months in the suboptimal group (chi(2) = 22.04, P = 0.0000). Prognosis of survival for individuals with progression-free interval >12 months was better than that of those with the interval 1.0 cm after primary operation should be considered prudently.     

Tertiary Cytoreduction for Recurrent Epithelial Ovarian Cancer: a Multicenter Study in Turkey

Background: The purpose of this study was to determine the benefit of tertiary cytoreductive surgery (TC) for secondary recurrent epithelial ovarian cancer (EOC), focusing on whether optimal cytoreduction has an impact on disease-free survival, and whether certain patient characteristics could identify ideal candidates for TC. Materials and Methods: Retrospective analysis of secondary recurrent EOC patients undergoing TC at three Turkish tertiary institutions from May 1997 to July 2014 was performed. All patients had previously received primary cytoreduction followed by intravenous platinum-based chemotherapy and secondary cytoreduction for first recurrence. Clinical and pathological data were obtained from the patients' medical records. Survival analysis was caried out using the Kaplan Meier method. Actuarial curves were compared by the two tailed Logrank test with a statistical significance level of 0.05. Results: Median age of the patients was 49.6 years (range, 30-67) and thirty-eight (72%) had stage III–IV disease at initial diagnosis. Twenty six (49%) had optimal and 27 (51%) suboptimal cytoreduction during tertiary debulking surgery . Optimal initial cytoreduction, time to first recurrence, optimal secondary cytoreduction, time interval between secondary cytoreduction and secondary recurrence, size of recurrence, disease status at last follow-up were found to be significant risk factors to predict optimal TC. Optimal cytoreduction in initial and tertiary surgery and serum CA-125 level prior to TC were independent prognostic factors on univariate analysis. Conclusions: Our results and a literature review clearly showed that maximal surgical effort should be made in TC, since patients undergoing optimal TC have a better survival. Thus, patients with secondary recurrent EOC in whom optimal cytoreduction can be achieved should be actively selected.     

提高复发性卵巢上皮癌手术切除率的探讨

背景与目的:复发性卵巢上皮癌能否手术切除对预后影响较大,提高复发性卵巢上皮癌的手术切除率有助于改善其预后。本研究旨在探讨如何提高复发性卵巢上皮癌的手术切除率。方法:回顾性分析1997年3月1日至2003年3月31日期间因复发性卵巢上皮癌在我院行第二次细胞减灭术的54例病例的临床资料。其中病灶部位局限于盆腔19例,超出盆腔35例。病灶数目为1个者16例,≥2个者38例。无腹水38例,有腹水16例。接受术前化疗20例,有效12例,无效8例。以 Logistic多因素回归,分析年龄、复发间隔时间、复发病灶部位、数目、有无腹水及复发术前化疗对复发术后残留灶的影响。结果:肿瘤的满意切除率为81.5％(44/54),其中无残留灶者占53.7％(29/54),残留灶≤2 cm者占27.8％(15/54)。Logistic分析显示,病灶部位及有无腹水是影响复发术后残留灶的显著性因素(P<0.05);复发术前化疗有效和无效患者的满意切除率分别为100％(12/12)和37.5％(3/8),卡方检验显示两者有非常显著性差异(P<0.01)。本组40.7％(22/54)的患者手术较复杂,涉及胃肠道、泌尿道或肝脾。术后并发症发生率为16.6％(9/54),手术死亡率1.9％(1/54)。结论:根据患者瘤灶的边界、部位、有无腹水及术前化疗的疗效,对复发患者进行适当的选择,并作好充分的术前准备有助于提高复     

The role of secondary cytoreductive surgery for recurrent mucinous epithelial ovarian cancer (mEOC)

Background

Mucinous epithelial ovarian cancer (mEOC) may exhibit a distinct biological behavior in epithelial ovarian cancer (EOC). The role of secondary cytoreductive surgery was evaluated in patients with recurrent mEOC, and the prognosis was assessed.

Methods

Twenty-one patients with stages IIc to IV mEOC who experienced disease recurrence and received secondary cytoreductive surgery at Fudan University Cancer Hospital between Jan. 1997 and Dec. 2005 were retrospectively reviewed. Survival curves were generated using the Kaplan–Meier method and the significant comparison of survival rate was estimated by the log-rank test.

Results

The median progression-free interval (PFI) was 14 months (range, 5–46 months) after the first cytoreduction. Seven patients (33%) who received secondary cytoreductive surgery were optimally cytoreduced with residual disease less than or equal 1 cm, and the other 14 patients (67%) underwent suboptimal surgical cytoreduction. The overall median survival time was 27 months (range, 8–64 months). The median survival time after recurrence was 10 months (range, 3–32 months). There was no significant statistical difference in median survival between patients with optimal and suboptimal secondary surgical cytoreduction, with an estimated survival of 10 months and 9.8 months, respectively (P > 0.05).

Conclusion

Optimal primary cytoreductive surgery for advanced mEOC was very important. Once it recurs, the prognosis is very poor. Patients with recurrent mEOC should be carefully assessed before performing secondary cytoreductive surgery, as this may have limited impact on the overall survival rates.     

The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma

BACKGROUND: This study examined the impact of secondary cytoreductive surgery on survival of patients with recurrent epithelial ovarian carcinoma. METHODS: One hundred six patients with a disease free interval (DFI) > 6 months after primary treatment underwent secondary cytoreductive surgery. Multivariate analysis determined which variables influenced the cytoreductive outcome and survival. RESULTS: Eighty-seven patients (82.1%) underwent removal of all visible tumor. The median and estimated 5-year survival for the entire cohort after recurrence was 35.9 months and 28%, respectively. The probability of complete cytoreduction was influenced by the largest size of recurrent tumor (< 10 cm ?90.0% vs. > 10 cm ?66.7%; P = 0.003), use of salvage chemotherapy before secondary surgery (chemotherapy given ?64.3% vs. chemotherapy not given ?93.8%; P = 0.001), and preoperative Gynecologic Oncology Group performance status (0 ?100%, 1 ?91.4%, 2 ?82.4%, and 3 ?47.4%; P = 0.001). Survival was influenced by the DFI after primary treatment (6-12 months ?median, 25.0 months vs. 13-36 months ?median, 44.4 months vs. > 36 months ?median, 56.8 months; P = 0.005), the completeness of cytoreduction (visibly disease free ?median, 44.4 months vs. any residual disease ?median, 19.3 months; P = 0.007), the use of salvage chemotherapy before secondary surgery (chemotherapy given ?median, 24.9 months vs. chemotherapy not given ?median, 48.4 months; P = 0.005), and the largest size of recurrent tumor (< 10 cm ?median, 37.3 months vs. > 10 cm ?median, 35.6 months; P = 0.04). CONCLUSIONS: Complete cytoreduction is possible for the majority of patients with recurrent epithelial ovarian carcinoma and maximizes survival if undertaken before salvage chemotherapy. The authors believe a randomized trial should be initiated to confirm these findings.     

Surgical cytoreduction in recurrent ovarian carcinoma in patients with complete response to paclitaxel-platinum.

AIM: The objective was to analyse the impact of secondary cytoreductive surgery in patients with recurrent ovarian carcinoma. METHODS: Retrospective review of 572 consecutive patients with primary ovarian carcinoma. Thirty-eight patients with intraabdominal/pelvic recurrence consisted the study group. Clinical variables affecting tumour resectability and survival were evaluated. RESULTS: Complete tumour resection was obtained in 42% of patients. A solitary tumour recurrence was independently associated with complete tumour resection (p=0.009). Median survival for patients with complete and incomplete tumour resection was 51.8 and 19.9 months. The parameter, residual tumour, was found independently correlated with survival after the relapse surgical procedure (p=0.02). However, including also the parameter, number of relapse tumour sites, in the multivariate analysis, the parameter, residual tumour, was no longer significantly associated with survival. CONCLUSIONS: Complete tumour resection following secondary cytoreductive surgery is associated with improved survival in selected groups of patients with recurrent ovarian cancer. However, other clinical factors than surgical cytoreduction are of considerable significance in determining the outcome of the salvage treatment.     

Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer: analysis of prognostic factors and survival outcome

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 or=12 months between initial diagnosis and recurrence, and or=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 >or=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.     

Prognostic factors of secondary cytoreductive surgery for patients with recurrent epithelial ovarian cancer

Objective

The objective of this study was to identify the prognostic factors of secondary cytoreductive surgery on survival in patients with recurrent epithelial ovarian cancer.

Methods

The medical records of all patients who underwent secondary cytoreductive surgery between May 2001 and October 2007 at the National Cancer Center, Korea were reviewed. Univariate and multivariate analyses were executed to evaluate the potential variables for overall survival.

Results

In total, 54 patients met the inclusion criteria. Optimal cytoreduction to <0.5 cm residual disease was achieved in 87% of patients who had received secondary cytoreductive surgery. Univariate analysis revealed that site of recurrence (median survival, 53 months for the largest tumors in the pelvis vs. 24 months for the largest tumors except for the pelvis; p=0.007), progression free survival (PFS) (median survival, 43 months for PFS≥12 months vs. 24 months for PFS<12 months; p=0.036), and number of recurrence sites (median survival, 49 months for single recurred tumor vs 29 months for multiple recurred tumors; p=0.036) were significantly associated with overall survival. On multivariate analysis, prognostic factors that correlated with improved survival were site of recurrence (p=0.013), and PFS (p=0.043).

Conclusion

In the author''s analysis, a significant survival benefit was identified for the recurred largest tumors within the pelvis and PFS≥12 months. Secondary cytoreductive surgery should be offered in selected patients and large prospective studies are needed to define the selection criteria for secondary cytoreductive surgery.     

Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent, platinum-sensitive epithelial ovarian carcinoma

BACKGROUND: The benefit of cytoreductive surgery for patients with recurrent epithelial ovarian cancer has not been defined clearly. The objective of this study was to identify prognostic factors for survival in patients who underwent secondary cytoreduction for recurrent, platinum-sensitive epithelial ovarian cancer and to establish generally applicable guidelines and selection criteria. METHODS: The authors reviewed all patients who underwent secondary cytoreduction for recurrent epithelial ovarian cancer from 1987 to 2001. Potential prognostic factors were evaluated in univariate and multivariate analyses. RESULTS: In total, 157 patients underwent secondary cytoreduction, and 153 of those patients were evaluable. After secondary cytoreduction, the median follow-up was 36.9 months (range, 0.2-125.6 months), and the median survival was 41.7 months (95% confidence interval, 36.0-47.2 months). For patients who had a disease-free interval prior to recurrence of between 6 months and 12 months, the median survival was 30 months compared with 39 months for patients who had a disease-free interval between 13 months and 30 months and 51 months for patients who had a disease-free interval >30 months (P = .005). For patients who had a single site of recurrence, the median survival was 60 months compared with 42 months for patients who had multiple sites of recurrence and 28 months for patients who had carcinomatosis (P <.001). The median survival for patients who had residual disease that measured < or =0.5 cm was 56 months compared with 27 months for patients who had residual disease that measured >0.5 cm (P <.001). On multivariate analysis, disease-free interval (P = .004), the number of recurrence sites (P = .01), and residual disease (P <.001) were significant prognostic factors. CONCLUSIONS: In the authors' analysis of secondary cytoreduction for recurrent epithelial ovarian cancer, a significant survival benefit was demonstrated for residual disease that measured < or = 0.5 cm. The disease-free interval and the number of recurrence sites should be used as selection criteria for offering secondary cytoreduction.     

Impact of secondary cytoreductive surgery on survival of patients with advanced epithelial ovarian cancer

Aims To investigate the impact on survival of secondary cytoreduction for advanced epithelial ovarian cancer and variables influencing redebulking surgical outcome. Methods Between 1986 and 1997, 106 patients who received secondary cytoreductive surgery and consequent second-line chemotherapy for stages III and IV epithelial ovarian cancer were retrospectively reviewed. The optimal residual disease cut-off was 1.0 cm. The Cox proportional regression model and logistic stepwise regression were used in statistical processing of the data. Results The median age of the patients was 50 years (range, 26–77 years). Optimal secondary cytoreduction was achieved in 46 of 106 patients (43.4%). There was a significant difference in survival between patients who were optimally cytoreduced compared to those suboptimaly cytoreduced, with an estimated median survival in the optimal group of 20 months vs 8 months in the suboptimal group (²=42.03, P=0.0000). When factorized, patients had significant survival benefit from optimal secondary cytoreduction for recurrent disease and interval cytoreduction. Survival was adversely influenced by progression-free interval ≤12 months (P=0.0078), residual disease >1 cm (P=0.0001) and presence of refractory ascites (P=0.0001). The probability of successful redebulking surgery was affected by presence of refractory ascites (P=0.0023) in all 106 patients and by the ascites (P=0.0072) and residual disease at initial operation in recurrent disease (P=0.0096). Conclusion Secondary surgical cytoreduction surgery significantly lengthened survival for patients with recurrent epithelial ovarian cancer or those receiving interval cytoreduction. Patients with refractory ascites, however, were not suitable for aggressive secondary surgery, and redebulking surgery for those with residual disease of >1.0 cm after primary operation should be considered prudently in recurrent disease.     

Intraoperative radiation therapy in recurrent ovarian cancer

PURPOSE: To evaluate disease outcomes and complications in patients with recurrent ovarian cancer treated with cytoreductive surgery and intraoperative radiation therapy (IORT). METHODS AND MATERIALS: A retrospective study of 24 consecutive patients with ovarian carcinoma who underwent secondary cytoreduction and intraoperative radiation therapy at our institution between 1994 and 2002 was conducted. After optimal cytoreductive surgery, IORT was delivered with orthovoltage X-rays (200 kVp) using individually sized and beveled cone applications. Outcomes measures were local control of disease, progression-free interval, overall survival, and treatment-related complications. RESULTS: Of these 24 patients, 22 were available for follow-up analysis. Additional treatment at the time of and after IORT included whole abdominopelvic radiation, 9; pelvic or locoregional radiation, 5; chemotherapy, 6; and no adjuvant treatment, 2. IORT doses ranged from 9-14 Gy (median, 12 Gy). The anatomic sites treated were pelvis (sidewalls, vaginal cuff, presacral area, anterior pubis), para-aortic and paracaval lymph node beds, inguinal region, or porta hepatitis. At a median follow-up of 24 months, 5 patients remain free of disease, whereas 17 patients have recurred, of whom 4 are alive with disease and 13 died from disease. Five patients recurred within the radiation fields for a locoregional relapse rate of 32% and 12 patients recurred at distant sites with a median time to recurrence of 13.7 months. Five-year overall survival was 22% with a median survival of 26 months from time of IORT. Nine patients (41%) experienced Grade 3 toxicities from their treatments. CONCLUSION: In carefully selected patients with locally recurrent ovarian cancer, combined IORT and tumor reductive surgery is reasonably tolerated and may contribute to achieving local control and disease palliation.     

Cytoreductive surgery and intraoperative hyperthermic chemoperfusion for advanced ovarian carcinoma

BACKGROUND: Optimal cytoreductive surgery combined with intraoperative hyperthermic chemoperfusion (IHCP) is a therapy that potentially could improve survival in a select group of patients with advanced ovarian cancer. The purpose of this study was to review the results of cytoreductive surgery and IHCP for advanced ovarian cancer and to identify factors that may predict which patients maximally benefit from this aggressive treatment. METHODS: Patients treated with cytoreduction followed by IHCP for ovarian cancer were identified from an IHCP database from 1/2001 through 3/2004. Several factors including resection status, peritoneal cancer index (PCI), and prior surgery were evaluated for their ability to predict survival in our cohort of patients. RESULTS: Thirteen patients with ovarian cancer treated with cytoreductive surgery followed by IHCP were identified. The 3-year overall survival rate for all thirteen patients was 55%. The median disease-free survival was 15.4 months (3-year disease-free survival, 11%). Several factors including PCI score (<6), ability to resect all gross disease, and previous surgical exploration appeared to impart an overall survival advantage. CONCLUSIONS: The use of IHCP coupled with optimal cytoreduction is a safe and effective treatment for advanced ovarian carcinoma. However, the proper selection of patients who will benefit most from the therapy is essential for the success of the treatment.     

Recurrent ovarian carcinoma: is there a place for surgery?

The role of cytoreductive surgery is well established in patients with primary ovarian carcinoma. Minimal residual disease translates to improved response to adjuvant treatment and prolonged survival. For close clinical follow-up, different approaches may be helpful in detecting recurrent disease, including regular physical/pelvic examination, serial CA-125 levels, and imaging studies using computerized tomography, magnetic resonance imaging, or positron emission testing. At recurrence, those patients with a good performance status, a good response to primary therapy, and a macronodular tumor distribution pattern may be candidates for a secondary cytoreductive procedure. Data suggests that secondary cytoreduction is superior to chemotherapy alone in patients who have a significant disease-free interval (6 to 12 months). Survival after secondary cytoreduction is optimized with cytoreduction to microscopic disease, yet there is a recognized risk of surgical morbidity. Therefore, a strong relationship between the gynecologic oncology surgeon and the patient is key to obtaining appropriate informed consent and relaying appropriate outcome expectations.     

肝脏部分切除术在复发性上皮性卵巢癌肝实质转移治疗中的价值

目的 探讨复发性上皮性卵巢癌肝实质转移患者行肝脏部分切除术的临床价值.方法 回顾性分析39例复发性上皮性卵巢癌肝实质转移患者的临床病理资料.结果 39例患者中,10例进行了肝脏部分切除术,29例仅行挽救性化疗.手术组患者的病变均为单叶,且病灶＜3个,与化疗组比较,差异有统计学意义(P＜0.05),在年龄、初次手术病理类型及病理分级、初次减瘤手术结果、初次治疗后的无瘤生存时间、肝转移瘤大小及肝转移时CA125水平等方面,差异均无统计学意义(P＞0.05).10例手术患者中,单纯行肝脏手术6例,同时行其他部位肿瘤细胞减灭术4例,其中7例减瘤手术满意.3例发生手术并发症,无手术死亡病例.8例肝脏病理切缘为阴性的患者中,局部复发6例,中位复发时间为术后12个月.减瘤手术满意的患者与行挽救性化疗的患者,肝转移后的中位总生存时间分别为26个月和9个月,肝转移后3年累积生存率分别为60.0%和16.8%,两组比较,差异有统计学意义(P＜0.05).结论 对存在肝实质转移的复发性上皮性卵巢癌患者施行包括肝脏部分切除术在内的满意肿瘤细胞减灭术,术后辅以化疗,有可能改善患者的预后.

Abstract：

Objective To investigate the validity of hepatic resection as a treatment option for hepatic parenchymal metastasis in patients with recurrent epithelial ovarian cancer. Methods A retrospective review of the clinicopathological and follow up data of 39 patients treated in our hospital from 1996 to 2008was conducted. Results Ten patients underwent partial hepatic resection for metastatic ovarian cancer.All the 10 patients underwent surgery were with unilobar metastasis and the number of tumors was lower than 3 (P ＜0.05).No significant difference existed in patient age,the primary pathology type and tumor grade,the rate of optimal primary cytoreductive surgery,the disease free survival after the primary therapy and the serum CA125 level at the liver metastasis when compared with the 29 patients accepted salvage chemotherapy(P ＞0.05).There were 7 patients who achieved optional surgery.The operation complication was 3/10 andthere was no perioperative mortality.There were 2 patients without postoperative chemotherapy in the 8 recurrent patients with microscopic negative margins.The median recurrence time was 12(5-24) months after the hepatic resection.The overall median survival periods after hepatic metastasis were 26 and 9 months and the 3-years cumulative survival rates were 60.0% and 16.8% for the optimal surgery patients including hepatic surgery and the salvage chemotherapy patients,respectively(P ＜0.05).Conclusion Hepatic resection for liver metastatic epithelial ovarian cancer is safe and may achieve long-term survival in patients after optimal second cytoreductive surgery.     

Primary cytoreductive surgery with rectosigmoid colon resection for patients with advanced epithelial ovarian carcinoma

BACKGROUND: The impact of radical bowel resection with multiple organ resection on the survival if patients with advanced ovarian carcinoma has not been well defined. The authors investigated whether primary cytoreductive surgery including rectosigmoid colon resection would affect the recurrence free interval and survival of these patients. METHODS: Between April 1990 and April 1997, 66 previously untreated Stage IIIC-IV ovarian carcinoma patients with macroscopic involvement of the rectosigmoid colon were enrolled. All patients underwent cytoreductive surgery with rectosigmoid colon resection to remove residual tumor less than 2 cm in greatest dimension and received 6 cycles of cisplatin-based postoperative chemotherapy. RESULTS: The median follow-up was 26 months (range, 7-104 months). In multivariate analysis, residual disease and depth of tumor infiltration of the bowel wall were independently associated with overall survival and recurrence free interval. Disease stage was independently associated only with overall survival. Residual tumor was the most strongly predictive factor for recurrence or death. The 2-year estimated survival rates according to the amount of residual tumor were 100% for 24 patients with no macroscopic residual disease and 77.3% for 28 patients with residual disease less than 1 cm. None of the 14 patients with residual disease larger than 1 cm were alive 2-years after operation. Overall, 48 patients (72.7%) developed disease recurrence: 43 (65.1%) in the abdomen, 19 (29.8%) in the liver, and 3 (4.5%) in the pelvis. CONCLUSIONS: The current findings suggest that cytoreductive surgery with rectosigmoid colon resection should be considered for ovarian carcinoma patients with bulky pelvic disease to help ensure that they are left with no residual disease after debulking surgery.     

Cytoreductive surgery for gynecologic malignancies--new standards of care

Studies on cytoreductive surgery for advanced ovarian and primary peritoneal cancer have consistently shown a strong correlation between cytoreduction and survival, with the best survival observed in patients who have no visible residual disease after successful cytoreductive surgery. Recent data that intraperitoneal chemotherapy further improves survival after optimal cytoreduction adds to the potential benefit of such surgery. More recently, significant survival benefit from optimal cytoreduction has also been shown for patients with recurrent disease and for women with advanced endometrial carcinoma. The selection criteria for patients and critical aspects of the operative technique and timing of cytoreductive surgery are discussed.     

影响复发上皮卵巢癌手术疗效的临床病理因素分析

  目的  分析影响复发卵巢上皮癌手术疗效的相关临床病理因素。   方法  采用Logistic回归方法进行分析, 并通过多因素Logistic逐步回归分析对接受手术治疗60例复发卵巢上皮性癌患者进行影响手术疗效的临床病理因素相关分析。   结果   1) 60例复发卵巢上皮癌术后平均中位生存时间为26个月(95%CI: 1 8.302~33.698), 其中肿瘤细胞减灭术满意者(残留灶≤2 cm)中位生存时间为28个月(95%CI: 25.043~30.957), 不满意者为16个月(95%CI: 13.184~18.816, P=0.002)。2)Logistic回归单因素分析显示复发数目、复发时伴有腹水、复发部位是影响手术满意效果的因素(P < 0.05);而年龄、初次手术情况、病理类型、细胞学分级、手术病理分期、初次化疗方案、复发距离末次化疗时间、复发CA125水平、最大复发病灶直径大小、术前先期化疗对手术效果无明显影响(P > 0.05)。3)Logistic逐步回归分析显示复发病灶个数、复发部位、复发后伴有腹水、年龄是影响手术满意度的主要因素。   结论  多个临床病理因素影响复发卵巢上皮癌手术疗效, 其中复发病灶个数、复发部位、复发后伴有腹水、年龄是影响手术满意度的主要因素。      

Cytoreductive surgery in the management of ovarian cancer

The standard management for previously untreated advanced-stage epithelial ovarian cancer is optimum cytoreductive surgery followed by aggressive cytotoxic chemotherapy. This approach is based on a retrospective review of a single-institution experience published more than 30 years ago and has yet to be confirmed in a prospective randomized trial. Many subsequent studies have supported the observation that advanced ovarian cancer patients who have the longest survival invariably have no macroscopic disease left at the completion of the initial surgery. The combination of a platinum- and taxane-based chemotherapy regimen is now well established as the most active one for treating women with advanced ovarian cancer. However, the overwhelming majority of patients with advanced ovarian cancer will eventually experience disease recurrence and develop resistance to cytotoxic chemotherapy. Selected patients with recurrent ovarian cancer--ie, those with an isolated recurrence identified more than 6 months following completion of initial chemotherapy and who have an excellent performance status--are managed with cytoreductive surgery followed by a platinum-based regimen. As in previously untreated patients, patients who have no macroscopic residual tumor left after secondary debulking for recurrent ovarian cancer have a significantly better survival than those left with any gross tumor. This article will review the role of surgery in the initial management of advanced-stage and recurrent ovarian cancer, focusing on the definition of optimum surgical cytoreduction.     

The role of surgery in ovarian cancer with special emphasis on cytoreductive surgery for recurrence

PURPOSE OF REVIEW: The role of cytoreductive surgery for recurrent ovarian cancer has not clearly been defined, and randomized trials are lacking. Some series have reported favorable outcomes for selected patients. This review summarizes the available evidence for selecting patients and the results of cytoreductive surgery in recurrent ovarian cancer. RECENT FINDINGS: A Medline search identified 23 series including 1795 patients (21-285 patients per study). Patients who underwent cytoreductive surgery for recurrence were highly selected. Complete tumor resection was feasible in 9 to 82% of patients and was commonly associated with prolonged survival. A variety of predictive and prognostic factors for complete resection were reported. Good performance status, disease characteristics (e.g. peritoneal carcinosis), and outcome of prior surgery seemed to have an impact on surgical outcome. By contrast, disease-free survival played only a minor role, especially in patients with recurrence later than 6 months after primary treatment. SUMMARY: Prospective evaluation of predictive scores for successful cytoreductive surgery in recurrent ovarian cancer is urgently needed. In a second step, randomized trials evaluating the role of surgery in the treatment strategy of recurrent ovarian cancer should be initiated. Until then, experienced and trained surgeons might offer surgery for recurrent disease to individually selected patients after giving information about the potential benefit and about the limited available evidence regarding this strategy.     

Impact of neoadjuvant chemotherapy on the survival of patients with stage IIIc and IV epithelial ovarian cancer

OBJECTIVE: To compare the survival of patients with stage IIc or IV epithelial ovarian cancer treated either with neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery or primary cytoreductive surgery (PCS) followed by adjuvant chemotherapy. METHODS: The clinical and pathological data of 160 patients with stage IIIc or IV epithelial ovarian cancer diagnosed pathologically between 1997 and 2005 were retrospectively reviewed. Forty-two patients were treated with NAC followed by cytoreductive surgery (NAC group) and 118 patients with PCS followed by adjuvant chemotherapy (PCA group). RESULTS: The overall response rate of NAC group was 69.1%. No significant difference was observed between the NAC group and PCS group in operating time, intra-operative blood loss and units of blood-transfusion (P > 0.05). Optimal cytoreductive surgery was performed in 88.1% of NAC group versus in 71.2% of PCS group (P < 0.05). In those who had optimal cytoreductive surgery, the recurrent rate was 43.2% in NAC group versus 56.0% in PCS group without significant difference between two groups (P > 0.05). The disease-free survival and progression-free survival was 7 and 8 months in NAC group, which were significantly shorter than 13 and 18 months in PCS group (P < 0.05), however, the median overall survival (OS) was 34 months in NAC group versus 43 months in PCS group without significant difference (P > 0.05). In the patients with optimal cytoreductive surgery, it was 34 months in NAC group versus 48 months in PCS group without significant difference either between two groups (P > 0.05). CONCLUSION: Neoadjuvant chemotherapy followed by cytoreductive surgery can improve the rate of optimal cytoreductive surgery for the patients with stage IIIc or IVepithelial ovarian cancer, but this regimen may neither reduce the recurrent rate nor prolong the survival when compared with the patients treated with primary cytoreductive surgery followed by adjuvant chemotherapy.