Prognostic impact of primary surgical outcome on survival after recurrence in patients with advanced ovarian cancer: Analysis of prospective randomized phase III trials.

Abstract

5100 Background: The prognostic role of complete debulking is well established at initial diagnosis of advanced ovarian cancer. Whether the result of primary surgery also has an impact on the clinical outcome after recurrence is not clear. Methods: Individual patient data meta-analysis of three prospective randomized AGO-OVAR/GINECO trials (AGO OVAR 3, 5 and 7) conducted between 1995 and 2002 to investigate platinum-taxane based chemotherapy regimens in advanced ovarian cancer. Results: A total of 3126 patients were analyzed. Approximately one third each had complete resection (microscopic residuals), small residual tumor (1-10 mm), or gross residual disease (> 10 mm) after primary surgery. There was no significant effect of the surgical outcome on further course of disease in patients developing progression within 12 months after primary therapy. However, patients experiencing recurrence later than 12 months after primary therapy showed a significantly different progression- free survival (PFS) and overall survival (OS) depending on initial surgical outcome. Median PFS after progression in the subgroups with microscopic residuals, 1-10 mm, or > 10 mm was 14.3, 12.6, and 12.0 months (logrank p = 0.0265) and the corresponding median OS was 28.1, 22.7, and 20.2 months, respectively (logrank p = 0.0079). This difference remained significant after adjustment for time-to-recurrence as continuous variable to rule out the effect of different time intervals before relapse (Cox model). Conclusions: Our analysis represents the first study investigating the relevance of primary surgical outcome for survival after recurrence in ovarian cancer. Complete surgical debulking significantly improves prognosis in advanced ovarian cancer not only at primary diagnosis but also after disease recurrence. No significant financial relationships to disclose.