Impact of complete cytoreduction leaving no gross residual disease associated with radical cytoreductive surgical procedures on survival in advanced ovarian cancer

Ann Surg Oncol. 2012 Dec;19(13):4059-67. doi: 10.1245/s10434-012-2446-8. Epub 2012 Jul 6.

Abstract

Background: To analyze the impact of radical cytoreductive surgery-as part of primary tumor debulking-on the amount of residual tumor and survival in patients with advanced ovarian cancer and to evaluate the prognostic significance of no gross residual disease (RD) after surgery.

Methods: Medical records of 203 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV ovarian cancer were reviewed. All patients underwent primary cytoreductive surgery followed by taxane- and platinum-based chemotherapy. Various clinicopathologic characteristics were collected.

Results: Of 203 patients, 119 patients underwent simple surgery, while radical surgery was performed in 84 patients. Advanced age (hazard ratio [HR] 1.04, 95 % confidence interval [CI] 1.02-1.06, P < 0.01), FIGO stage IV disease (HR 3.61, 95 % CI 1.48-8.83, P < 0.01), and grossly visible RD (HR 3.24, 95 % CI 1.90-5.53, P < 0.01) were identified as significant factors associated with poor prognosis in the entire cohort of 203 patients. Radical surgery (HR 0.56, 95 % CI 0.37-0.87, P = 0.01) was associated with improved survival. In the subgroup of patients with stage IIIC disease with peritoneal carcinomatosis, independent prognostic factors were advanced age (HR 1.04, 95 % CI 1.01-1.06, P = 0.01), radical surgery (HR 0.58, 95 % CI 0.35-0.96, P = 0.03), and grossly visible RD (HR 2.86, 95 % CI 1.55-5.30, P < 0.01). Patients with no gross RD had the longest overall survival (86 months) compared with RD 0.1-1 cm (46 months) and RD >1.0 cm (37 months) (P < 0.01).

Conclusions: No gross RD is associated with improved overall survival, and radical surgery was effective for achieving no gross RD.

MeSH terms

  • Adenocarcinoma, Clear Cell / drug therapy
  • Adenocarcinoma, Clear Cell / mortality
  • Adenocarcinoma, Clear Cell / surgery
  • Adenocarcinoma, Mucinous / drug therapy
  • Adenocarcinoma, Mucinous / mortality
  • Adenocarcinoma, Mucinous / surgery
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Chemotherapy, Adjuvant
  • Combined Modality Therapy
  • Cystadenocarcinoma, Serous / drug therapy
  • Cystadenocarcinoma, Serous / mortality
  • Cystadenocarcinoma, Serous / surgery
  • Endometrial Neoplasms / drug therapy
  • Endometrial Neoplasms / mortality
  • Endometrial Neoplasms / surgery
  • Female
  • Follow-Up Studies
  • Gynecologic Surgical Procedures*
  • Humans
  • Lymphatic Metastasis
  • Middle Aged
  • Neoadjuvant Therapy
  • Neoplasm Grading
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / mortality*
  • Neoplasm Recurrence, Local / surgery
  • Neoplasm Staging
  • Neoplasm, Residual / drug therapy
  • Neoplasm, Residual / mortality*
  • Neoplasm, Residual / surgery
  • Ovarian Neoplasms / drug therapy
  • Ovarian Neoplasms / mortality*
  • Ovarian Neoplasms / surgery
  • Peritoneal Neoplasms / drug therapy
  • Peritoneal Neoplasms / mortality*
  • Peritoneal Neoplasms / surgery
  • Prognosis
  • Survival Rate