Abstract
ObjectiveEarly recurrence (ER) after completion of therapeutic regimen in advanced-stage ovarian cancer is a challenging clinical situation. Patients are perceived as invariably having a poor prognosis. We investigated the possibility of defining different prognostic subgroups and the parameters implicated in prognosis of ER patients.Study DesignWe analyzed a multi-centric database of 527 FIGO stage IIIC and IV ovarian cancer patients. We defined patients relapsing within 12 months as ER and investigated using Cox logistic regression the prognostic factors in ER group. We subsequently divided ER patients into good and poor prognosis groups according to a lower or higher overall survival (OS) at 12 months after relapse and determined parameters associated to poor prognosis.ResultsThe median follow up was 49 months. One hundred and thirty eight patients recurred within 12 months. OS and Disease Free Survival (DFS) were 24.6 and 8.6 months, respectively, in this group of patients. Among the ER patients, 73 had a poor prognosis with an OS after relapse below 12 months (mean OS = 5.2 months) and 65 survived after one year (mean OS = 26.9 months). Residual disease (RD) after debulking surgery and mucinous histological subtype negatively impacted prognosis (HR = 1.758, p = 0.017 and HR = 8.641, p = 0.001 respectively). The relative risk of death within 12 months following relapse in ER patients was 1.61 according to RD status. However, RD did not affect DFS (HR = 0.889, p = 0.5).ConclusionER in advanced-stage ovarian cancer does not inevitably portend a short-term poor prognosis. RD status after initial cytoreduction strongly modulates OS, that gives additional support to the concept of maximum surgical effort even in patients who will experience early recurrence. The heterogeneity in outcomes within the ER group suggests a role for tumor biology in addition to classical clinical parameters.
Highlights
Relapse in cancer management is still a challenging clinical situation
We investigated the possibility of defining different prognostic subgroups and the parameters implicated in prognosis of Early recurrence (ER) patients
Characteristics of patients with early recurrence. This previously described database was consistent regarding demographics, therapeutic management and outcomes with previous studies focusing on advanced-stage ovarian cancer
Summary
Relapse in cancer management is still a challenging clinical situation. Despite achievement of complete clinical remission after initial treatment, 60% of patients with advanced stages will relapse within five years [6]. Among them, those presenting with early recurrence are often perceived as having a poor prognosis. Platinum-based combination therapy is usually recommended in patients with recurrence from 6 to 12 months after completion of first line treatment while diseases recurring within the first 6 months are considered platinum resistant and require different therapeutic regimen [8,9,10]
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