A risk model for secondary cytoreductive surgery in recurrent ovarian cancer: An evidence-based proposal for patient selection.

Abstract

5053 Background: This study aims to redefine the role of secondary cytoreductive surgery (SCR) and develop a risk model for predicting outcomes of SCR in patients with recurrent ovarian cancer. Methods: Individual data of patients with recurrent ovarian cancer undergoing SCR from seven world-wide centers were pooled analyzed. The risk model was developed based on the factors impacting on SCR outcome. Additional data of 117 patients were used for external validation and 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 to 27.0 months and 15.6 months in those with residual disease of 0.1-1cm and >1cm, respectively (P< 0.0001). Of the 1075 patients, 434 (40.4%) underwent complete resection. Complete SCR was associated with six variables: FIGO stage (OR=1.32), residual disease after primary cytoreduction (OR=1.69), progression-free interval (OR=2.27), ECOG performance status (OR=2.23), CA125 (OR=1.85) and ascites at recurrence (OR=2.79). These variables were entered into the risk model and assigned scores ranging from 0 to 11.9. Patients with total scores of 0-4.7 were categorized as the low risk group, in which the proportion of complete cytoreduction was 53.4% compared to 20.1% in the high risk group (OR=4.55). In external validation, the sensitivity and specificity of the model was 83.3% and 57.6%, respectively. Conclusions: SCR may be recommended for selected patients with recurrent ovarian cancer. This model may well predict the outcome of SCR and determine who benefit from SCR.