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Value of Tertiary Cytoreductive Surgery in Epithelial Ovarian Cancer: An International Multicenter Evaluation |
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| Authors: | Christina Fotopoulou MD PhD Rongyu Zang MD PhD Murat Gultekin MD David Cibula MD PhD Ali Ayhan MD PhD Dongli Liu MD Rolf Richter PhD Ioana Braicu MD Sven Mahner MD PhD Philipp Harter MD Fabian Trillsch MD Sanjeev Kumar MD Michele Peiretti MD PhD Sean C. Dowdy MD FACS Angelo Maggioni MD Claes Trope MD PhD Jalid Sehouli MD PhD |
| Affiliation: | 1. Department of Gynaecology, European Competence Center for Ovarian Cancer, Charité, Campus Virchow Clinic, University Hospital, Berlin, Germany 2. Department of Gynecologic Oncology, Fudan University Cancer Hospital, Shanghai, China 3. Cancer Control Department, Zekai Tahir Burak Women’s Health and Research Hospital and Turkish Ministry of Health, Ankara, Turkey 4. Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Gynecologic Oncology Center, Charles University in Prague and General University Hospital, Prague, Czech Republic 5. Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey 6. Department of Gynaecology and Gynaecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany 7. Departments of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany 8. Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA 9. Gynecologic Oncology Department, European Institute of Oncology, Milan, Italy 10. Department of Gynaecologic Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway 11. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway |
| Abstract: | BackgroundThe value of surgery for recurrent epithelial ovarian cancer (OC) is controversial. The aim of the present study was to evaluate the outcome of EOC-patients who underwent tertiary cytoreductive surgery (TCS) and to identify prognostic markers for complete tumor resection and survival.MethodsRetrospective multicenter evaluation of TCS patients treated between 1997 and 2011 in 14 centers across Europe, the United States, and Asia.ResultsWe evaluated 406 patients (median age, 55 years; range, 16–80 years). Median time from first to second recurrence was 18 months (2–204 months). Median follow-up from TCS was 14 months (0–182 months), and median OS was 26 months (95 % CI, 19.62–32.38 months). Median OS for patients without versus any tumor residuals was 49 months (95 % CI, 42.5–56.4 months) versus 12 months (95 % CI 9.3–14.7 months) (p < 0.001). The majority of the patients had an advanced initial FIGO stage III/IV (69 %), peritoneal carcinomatosis (51.7 %), and absence of ascites (72.2 %). A total of 224 patients (54.1 %) underwent complete tumor resection. The most frequent tumor dissemination site was the pelvis (73 %). Rates of major operative morbidity and 30-day mortality were 25.9 % and 3.2 %, respectively. Multivariate analysis identified platinum resistance, tumor residuals at secondary surgery, and peritoneal carcinomatosis to be of predictive significance for complete tumor resection, while tumor residuals at secondary and tertiary surgery, decreasing interval to second relapse, ascites, upper abdominal tumor involvement, and nonplatinum third-line chemotherapy significantly affected OS.ConclusionsIn this largest known database for TCS, residual tumor retains its high impact on survival even in the tertiary setting of OC. In specialized centers high rates of complete tumor resection can be obtained. Prospective analyses are warranted to define the value of TCS in EOC. |
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