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.     

影响上皮性卵巢癌复发患者预后相关临床病理因素分析

目的分析影响上皮性卵巢癌(epithelial ovarian cancer,EOC)复发患者预后的相关临床病理因素。方法采用Kaplan-meier生存率曲线,Log rank检验和Cox模型多因素回归分析法对92例临床病理及随访资料完整的复发癌患者进行影响其预后的相关因素分析。结果(1)92例复发上皮性卵巢癌临床病例的总体中位生存时间是18月(95%CI:16.052~19.948);(2) Kaplan-Meier单因素分析提示,FIGO分期、复发距离末次化疗时间、复发部位、最大复发病灶、复发后伴有腹水、CA125升高、复发后二次肿瘤细胞减灭术、再次治疗化疗方案是影响复发EOC患者的重要预后因素(P<0.1)。而年龄、肿瘤细胞分级、初次治疗方案与预后无关(P>0.1);(3)Cox回归分析结果显独示,复发后再次治疗化疗方案、最大复发病灶大小、复发部位是影响患者预后的独立危险因素。结论 多个临床病理因素影响复发上皮性卵巢癌预后,其中复发后再次治疗化疗方案、最大复发病灶大小、复发部位是影响患者预后的独立危险因素。     

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.     

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.     

根治术后局部复发性直肠癌的预后因素分析

目的 探讨影响直肠痛根治术后局部复发患者预后因素以及术后联合辅助治疗的疗效.方法 搜集2000年4月至2004年4月间105例局部复发性直肠癌再次治疗患者的病例资料和随访结果,回顾分析17项临床病理因素和患者预后的关系.确定影响局部复发性直肠癌预后的独立因素并对复发后不同治疗方式进行评价.结果 随访率为95.2%,1、3、5年总生存率分别为63%、34%、19%,中位生存时间23个月.手术+放化疗(34例),单纯手术(35例)和放化疗(36例)的1、3、5年生存率分别为79%、55%、32%,68%、40%、14%和64%、36%、11%(χ~2=7.96,P=0.019).单因素分析结果表明原发肿瘤组织学分级、浸润深度、转移淋巴结数、首次术后分期、复发部位、复发时间及复发后治疗方式与预后相关;其中首次术后TNM分期、复发部位、复发时间和复发后治疗方法是影响根治术后局部复发直肠癌患者预后的独立因素.手术联合放化疗的5年生存率明显优于单纯手术及单纯辅助治疗.结论 首次术后TNM分期、复发部位、复发时间和复发后治疗方式是局部复发性直肠癌的独立预后因素,手术联合放化疗可能会给局部复发性直肠癌患者带来长期生存机会.     

Hyperthermic intraperitoneal chemotherapy with oxaliplatin and without adjuvant chemotherapy in stage IIIC ovarian cancer

ObjectiveTo assess the feasibility and efficacy of cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) without adjuvant chemotherapy for relapsed or persistent advanced ovarian cancer.MethodsThis observational study included stage IIIC ovarian cancer patients due to undergo CRS (interval debulking or recurrent surgery) followed by HIPEC with oxaliplatin (460 mg/m²) for 30 min.ResultsTwenty-two patients (12 interval debulking procedures and 10 recurrence procedures) were enrolled between September 2003 and September 2007. HIPEC was not performed in four patients because of operative findings. No patient received adjuvant chemotherapy after HIPEC. Patients were followed up routinely until recurrence or death. Median peritoneal cancer index at surgery was 6 (range: 1-18). Before HIPEC, all patients had completeness of cytoreduction scores of 0 or 1. Median length of hospital stay was 21 days (range 13-65). Ten patients (55.6%) had CTCAE grade 3-4 toxicity, including three patients (16.7%) requiring reoperation. No postoperative mortality was observed. With a median follow-up of 38 months (CI 95% 23.8-39.2), median overall survival was not reached. The 3-year overall survival rate was 83% (CI 95% 54-95). Median disease-free survival was, respectively, 16.9 months (CI 95% 10.2-23.2) and 10 months (CI 95% 4.5-11.3) for patients undergoing interval debulking or recurrence surgery.ConclusionHIPEC without adjuvant chemotherapy is both feasible and safe, but with a high rate of grade 3-5 toxicity. Survival results are encouraging but should be confirmed in a randomized trial.     

上皮性卵巢癌初次肿瘤细胞减灭术后复发情况及影响因素分析

目的:研究上皮性卵巢癌初次肿瘤细胞减灭术后复发情况以及影响因素分析,旨在为降低上皮性卵巢癌初次肿瘤细胞减灭术后复发提高患者术后生存质量提供有效的理论依据。方法:采用回顾性方法分析我院在2008年1月至2012年12月期间进行肿瘤细胞减灭术治疗的186例上皮性卵巢癌患者的临床资料,术后根据患者复发情况将患者分成复发组与未复发组。观察两组患者年龄、组织学类型、化疗方式、新辅助化疗、临床分期、组织分级、残余病灶、腹水、术前HE4、术后2月CA125、淋巴结切除之间的差异,同时分析影响上皮性卵巢癌初次肿瘤细胞减灭术后复发的独立危险因素。结果:随访5年,复发患者有78例,复发率为41.94%,未复发患者108例;复发组与未复发组患者在年龄、组织学类型、化疗方式、新辅助化疗等因素中比较无差异（P＞0.05）,在临床分期、组织分级、残余病灶、腹水、术前HE4、术后2月CA125、淋巴结切除中存在明显差异（P＜0.05）;经Logistic回顾分析证明,临床分期、残余病灶、腹水、术前HE4、淋巴结切除是临床上皮性卵巢癌患者初次肿瘤细胞减灭术后复发的独立危险因素［OR=9.786（3.484~27.493）、OR=8.199（4.431 ~15.172）、OR=9.143（3.975~21.031）、OR=9.337（4.593~18.983）、OR=11.917（6.440~22.053）］。结论:上皮性卵巢癌患者经初次肿瘤细胞减灭术治疗后,复发率为41.94%左右,而影响患者术后复发的独立危险因素为临床分期、残余病灶、腹水、术前HE4、淋巴结切除等,临床上可针对这些因素进行干预降低临床术后复发率,提高患者生活质量。     

First-line treatment of advanced ovarian cancer with paclitaxel/carboplatin with or without epirubicin (TEC versus TC)--a gynecologic cancer intergroup study of the NSGO, EORTC GCG and NCIC CTG

Background The addition of anthracyclines to platinum-based chemotherapy may provide benefit in survival in ovarian cancer patients. We evaluated the effect on survival of adding epirubicin to standard carboplatin and paclitaxel. Patients and methods We carried out a prospectively randomized phase III study comparing carboplatin plus paclitaxel (TC; area under the curve 5 and 175 mg/m(2)) with the same combination and epirubicin (TEC; 75 mg/m(2) i.v.). Between March 1999 and August 2001, 887 patients with epithelial ovarian, tubal or peritoneal cancer International Federation of Gynecology and Obstetrics stages IIB-IV were randomized to receive either TC (442 patients) or TEC (445 patients). Results Median time to progression was 16.4 months in the TEC arm and 16.0 months in the TC arm (hazard ratio 0.99; 95% confidence interval [CI]: 0.9-1.2). Median overall survival time was 42.4 months for the TEC arm and 40.2 for the TC arm (hazard ratio 0.96; 95% CI: 0.8-1.1). Grade 3/4 hematologic toxic effects and most grade 3/4 non-hematologic toxic effects were more frequent in the TEC arm. Accordingly, a quality-of-life analysis showed inferiority of TEC versus TC. Conclusion The addition of epirubicin to standard carboplatin and paclitaxel treatment did not improve survival in patients with advanced ovarian, tubal or peritoneal cancer.     

上皮性卵巢癌复发的影响因素分析

背景与目的:中晚期上皮性卵巢癌复发率较高,生存率低。在没有可靠的早期诊断技术的情况下,了解其复发的影响因素对于预后的判断和指导治疗具有非常重要的意义。本文旨在探讨上皮性卵巢癌复发的影响因素。方法:109例上皮性卵巢癌,对可能导致病人复发的影响因素:年龄,病理类型,临床分期,新辅助化疗,术后化疗方案和化疗疗程,初次手术治疗情况;以及手术残留癌灶大小,用Logistic回归方法进行回顾性总结和分析。结果:109例患者中复发36例,复发率为33.0％,中位复发时间19个月;109例病人总的5年生存率为62.7％,复发病人5年生存率43.3％;盆腔复发病人的5年生存率为50.1％,盆腔外复发病人的5年生存率36.1％,二者相比较无统计学意义(P>0.05)。单因素分析分别显示粘液性腺癌和临床分期为Ⅰ期的复发风险较低(回归系数β=1.565和-1.799,P=0.0120和0.026);而化疗疗程>8个疗程的病人复发风险明显高于1～4疗程和6～8疗程 的病人(回归系数β=-3.591和-1.500,P<0.001和=0.038)。多因素分析显示病理类型、临床分期和术后化疗疗程数是影响卵巢癌治疗后复发的独立危险因素(RR=3.473,4.713和6.140,P<0.05)。结论:临床分期是影响复发的显著因素,早期诊断对于降低卵巢癌复发率十分重要。合理的化疗计划对于卵巢癌的治疗是必要的,     

Melphalan for the treatment of patients with recurrent epithelial ovarian cancer

The purpose of this study was to determine the response to melphalan in patients with recurrent epithelial ovarian cancer after platinum-based therapy. This retrospective observational study analyzed 10 patients with recurrent epithelial ovarian carcinoma treated with melphalan between August 1995 and April 2001. All had received primary platinum-based therapy. Nine of the 10 patients had chemosensitive disease. All but one patient had received one or more second-line therapies prior to melphalan. The median time to recurrence after first-line therapy was 26 months (range, 3-68). Treatment with melphalan resulted in 2 (20%) complete responses and 1 (10%) partial response (response rate, 30%; 95% CI 8%, 65%). The median progression-free interval after initiation of melphalan therapy was 8 months (range, 3-23). The most common side effects were grade I thrombocytopenia (20% of courses) and grade II leukopenia (18% of courses). The use of melphalan as palliative chemotherapy in patients with recurrent ovarian cancer results in response rates similar to those reported with other more expensive agents. Melphalan at the doses reported here has a favorable toxicity profile.     

International Collaborative Ovarian Neoplasm trial 1: a randomized trial of adjuvant chemotherapy in women with early-stage ovarian cancer

BACKGROUND: The question of whether platinum-based adjuvant chemotherapy can improve outcomes in patients with early-stage epithelial ovarian cancer is an important one. We carried out a multicenter, open randomized trial to determine whether adjuvant chemotherapy would improve overall survival and prolong recurrence-free survival in women with early-stage epithelial ovarian cancer. METHODS: Between August 1991 and January 2000, 477 patients in 84 centers in five countries were randomly assigned to receive either adjuvant chemotherapy immediately following surgery (n = 241) or no adjuvant chemotherapy until clinically indicated (n = 236). Kaplan-Meier curves of overall survival and recurrence-free survival were compared using the Mantel-Cox version of the log-rank test. All statistical tests were two-sided. RESULTS: Women who received adjuvant chemotherapy had better overall survival than women who did not (hazard ratio [HR] of 0.66, 95% confidence interval [CI] = 0.45 to 0.97; P =.03). These results translate into 5-year survival figures of 70% for women who did not receive adjuvant chemotherapy and 79% for women who did receive adjuvant chemotherapy, a difference of 9% (95% CI = 1% to 15%). Adjuvant chemotherapy also improved recurrence-free survival (HR = 0.65; 95% CI = 0.46 to 0.91; P =.01). These results translate into 5-year recurrence-free survival figures of 62% for women who did not receive adjuvant chemotherapy and 73% for women who did receive adjuvant chemotherapy, a difference of 11% (95% CI = 3% to 18%). CONCLUSION: These results suggest that platinum-based adjuvant chemotherapy improves survival and delays recurrence in patients with early-stage ovarian cancer.     

Molecular prognostic markers in recurrent and in non-recurrent epithelial ovarian cancer

BACKGROUND: The outcome and prognosis of ovarian cancer is highly variable. The objective of this study was to compare survival and clinicopathological prognostic factors with the expression levels of two matrix metalloproteinases (MMP) and fibronectin as tumor invasion and metastasis markers in ovarian cancer patients. MATERIALS AND METHODS: Histologically-verified epithelial ovarian tumours from 27 patients were studied. The latent and the activated forms of MMP-2 and MMP-9 were measured as gelatinase activity from tumour extracts and from serum and ascites samples by a zymographic technique. The fibronectin content was quantified by immunoblotting and densitometric analysis. Molecular marker levels were correlated to clinicopathological parameters such as survival and disease recurrence during the median postoperative follow-up period of 30 months. RESULTS: The levels of MMP-9 and fibronectin, but not those of MMP-2, were significantly higher in tumour tissues and in the ascites fluid of the recurrent patient group and the patient group who did not survive, as compared to the non-reccurent cases. CONCLUSION: Our data support that high expression of MMP-9 and fibronectin indicate poor prognosis for ovarian cancer patients who have similar clinicopathological prognostic factors.     

CXCL12及受体CXCR4在卵巢上皮性癌中的表达及其临床意义

目的:探讨趋化因子CXCL12及其受体CXCR4在卵巢上皮性癌组织中的表达及与临床病理特征和预后的关系。方法:采用免疫组织化学SP法检测6例正常卵巢表面上皮、44例卵巢上皮性癌原发灶和30例相应大网膜转移灶组织中的CXCL12和CXCR4蛋白表达。结果:正常卵巢表面上皮无CXCL12和CXCR4蛋白表达;卵巢上皮性癌原发灶的CXCL12和CXCR4表达阳性率分别为91%和59%。CXCL12表达强度与术中腹水量有显著相关性(P=0.014)。难治复发组的CXCR4阳性率(81%)显著高于无复发组(28%,P<0.001)。单因素分析显示:CXCR4阳性表达的患者中位数肿瘤无进展生存时间和总生存时间(15个月、27个月)明显短于CXCR4阴性表达者(>21个月、>32个月,分别为P<0.001和P=0.017)。多因素分析显示:CXCR4表达和残余灶大小是影响卵巢上皮性癌患者的肿瘤无进展生存时间和总生存时间的独立预后因素。结论:CXCR4在卵巢上皮性癌中的表达阳性率较高,是影响其预后的独立指标之一。     

Altretamine is an effective palliative therapy of patients with recurrent epithelial ovarian cancer

BACKGROUND: Management of patients with recurrent epithelial ovarian cancer is difficult. Although several agents are active, responses are short-lived and observed in only a small number of patients. Side effects of these drugs are substantial. There is a need for more effective and less toxic therapies. Altretamine is a well tolerated oral agent with minimal toxicity. There are only a few trials evaluating its efficacy as a single agent in recurrent epithelial ovarian cancer. METHODS: We prospectively studied patients with recurrent epithelial ovarian cancer who were able to take oral medication and had adequate bone marrow, liver and renal functions. All had been previously treated with at least one platinum-based chemotherapy regimen and had either relapsed or failed to achieve an adequate response. RESULTS: Seventeen patients were studied. The commonest histological subtype was serous adenocarcinoma. Seven patients had platinum refractory disease. The mean duration of therapy was 6.1 months. Six patients (35%) achieved complete or partial remission, time to progression was 6.0 months and mean overall survival was 15.1 months. Toxicity was primarily nausea, vomiting and asthenia and was easily manageable. CONCLUSION: Altretamine is an acceptable and apparently less toxic alternative to other cytotoxic drugs used for palliation of patients with recurrent epithelial ovarian cancer.     

An analysis of 117 cases of patients who died from tumor recurrence or from the progression of ovarian malignancies

Out of 403 patients with ovarian with malignancies during 1978 to, 1985, 117 (29.0%) died from the progression of a non-curative cancer (56 cases, 47.9%) or from a cancer recurrence (61 cases, 52.1%). The mean survival rate 117 cases was 13.4 months, of which 103 (88.0%) cases concerned patients who died within 2 years and 114 (97.4%) who died within 3 years. A histological analysis revealed that patients with a serous or an endometrial cancer had a longer survival rate than others. Among 61 recurrent cases, 59 (96.7%) fell into recurrence within 2 years. Regarding the relationship between a recurrent of cancer and its prognosis, patients with a recurrence of an ascitic or a metastatic disease had a poorer prognosis than patients with a pelvic or an abdominal mass. An aggressive operation, such as a resection of a recurrent tumor, even if small in volume, led to a better prognostic result than no therapy.     

Season of Diagnosis and Survival of Advanced Lung Cancer Cases - Any Correlation?

Introduction: The influence of season at diagnosis on cancer survival has been an intriguing issue for manyyears. Most studies have shown a possible correlation in between the seasonality and some cancer type survival.With short expected survival, lung cancer is an arena that still is in need of new prognostic factors and models.We aimed to investigate the effect of season of diagnosis on 3 months, 1 and 2 years survival rates and overallsurvival of non small cell lung cancer patients. Materials and Methods: The files of non small cell lung cancerpatients that were stages IIIB and IV at diagnosis were reviewed retrospectively. According to diagnosis date,the patients were grouped into 4 season groups, autumn, winter, spring and summer. Results: A total of 279advanced non small cell lung cancer patients’ files were reviewed. Median overall survival was 15 months in theentire population. Overall 3 months, 1 and 2 years survival rates were 91.0%, 58.2% and 31.2% respectively.The season of diagnosis was significantly correlated with 3 months survival rates, being diagnosed in springbeing associated with better survival . Also the season was significantly correlated with T stage of the disease.For 1 and 2 years survival rates and overall survival, the season of diagnosis was not significantly correlated.There was no correlation detected between season and overall survivals according to histological subtypes ofnon small cell lung cancer. Conclusion: As a new finding in advanced non small cell lung cancer patients, it canbe concluded that being diagnosed in spring can be a favorable prognostic factor for short term survival.     

复发卵巢上皮性癌的治疗与预后分析

目的 探讨复发卵巢上皮性癌的治疗措施及预后影响因素.方法 收集293例接受系统治疗的初治卵巢上皮性癌患者的临床资料,对在随访过程中复发的199例患者进行回顾性分析.结果 199例复发患者均接受了化疗,其中173例接受了单纯化疗,16例接受了手术治疗+化疗,10例接受了化疗+放疗.158例患者再次接受了以铂类为基础的化疗,而41例患者接受了不含铂类的化疗.全部患者总的有效率为43.7%(87/199),其中单纯化疗的有效率为39.9%(69/173),手术治疗+化疗的有效率为75.0%(12/16),化疗+放疗的有效率为60.0%(6/10).接受单纯化疗的173例患者中,无进展时间(PFI)≤6个月、7～12个月、13～24个月和＞24个月组的化疗有效率分别为5.1%、47.2%、82.1%和96.0%.接受再次肿瘤细胞减灭术治疗的16例患者中位总生存时间为41个月.单因素分析结果 显示,组织分化和PFI与复发卵巢上皮性癌的预后有关.Cox回归多因素分析结果 显示,PFI是复发卵巢上皮性癌预后的独立影响因素(OR=0.589,P=0.021).结论 PFI与化疗有效率有关,随着PFI的延长,化疗的有效率逐渐提高.紫杉醇+铂类方案对铂类敏感型患者的有效率要高于其他铂类联合方案.PFI是复发卵巢上皮性癌患者预后的独立影响因素.     

The role of bevacizumab in recurrent,platinum-sensitive ovarian cancer

The majority of women with ovarian cancer will experience a recurrence of their disease despite aggressive primary cytoreduction and adjuvant cytotoxic chemotherapy. Notwithstanding the high rate of recurrence, targeted and biologic agents have helped to decrease the dependence on cytotoxic chemotherapy. Bevacizumab, a vascular endothelial growth factor inhibitor, has been shown to cause regression in tumor vasculature, inhibition of angiogenesis and prevention of progenitor cell recruitment. Phase III clinical trials of bevacizumab in patients with primary epithelial ovarian cancer and in patients with platinum-sensitive ovarian cancer have shown an improvement in progression free survival without an appreciable difference in overall survival. The addition of bevacizumab to standard cytotoxic chemotherapy regimens has demonstrated improved response rates, and improved progression free survival. These results have stimulated research in additional angiogenesis inhibitors and trials to further incorporate bevacizumab into the treatment schema for patients with recurrent ovarian cancer.     

Surgical treatment of locally recurrent rectal cancer.

BACKGROUND: The aim of our study was to analyse data of patients treated by salvage surgery for locally recurrent rectal cancer, with emphasis on the question whether salvage surgery is still worthwhile when adjuvant radiotherapy is no longer a treatment option. METHODS: Forty patients (19 males/21 females) treated by surgery with curative intent for locally recurrent rectal carcinoma were analysed. Local recurrence was defined as cancer recurrence within the lower pelvis. Salvage surgery included abdominoperineal resection, abdominosacral resection, exenteration (posterior or total) and local resection. Clinical and pathological factors were analysed to identify prognostic factors for survival. RESULTS: The median overall survival was 25 months (95% CI: 13-37 months) and 5-year survival was 28% (95% CI: 12-45%). The absence of symptoms at the time of recurrence, central localisation and the absence of microscopic involvement of surgical margins, but not additional radiotherapy, were found to be significant independent prognostic factors for better survival after salvage surgery. CONCLUSION: Salvage surgery, alone or in combination with radiotherapy, can achieve radical resection of locally recurrent rectal cancer and can result in long-term survival.     

Predictors of survival in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery based on the pooled analysis of an international collaborative cohort

Background:

This study aims to identify prognostic factors and to develop a risk model predicting survival in patients undergoing secondary cytoreductive surgery (SCR) for recurrent epithelial ovarian cancer.

Methods:

Individual data of 1100 patients with recurrent ovarian cancer of a progression-free interval at least 6 months who underwent SCR were pooled analysed. A simplified scoring system for each independent prognostic factor was developed according to its coefficient. Internal validation was performed to assess the discrimination of the model.

Results:

Complete SCR was strongly associated with the improvement of survival, with a median survival of 57.7 months, when compared with 27.0 months in those with residual disease of 0.1–1 cm and 15.6 months in those with residual disease of >1 cm, respectively (P<0.0001). Progression-free interval (⩽23.1 months vs >23.1 months, hazard ratio (HR): 1.72; score: 2), ascites at recurrence (present vs absent, HR: 1.27; score: 1), extent of recurrence (multiple vs localised disease, HR: 1.38; score: 1) as well as residual disease after SCR (R1 vs R0, HR: 1.90, score: 2; R2 vs R0, HR: 3.0, score: 4) entered into the risk model.

Conclusion:

This prognostic model may provide evidence to predict survival benefit from secondary cytoreduction in patients with recurrent ovarian cancer.