Proposal for selection criteria of secondary cytoreductive surgery in recurrent epithelial ovarian, tubal, and peritoneal cancers.

Abstract

The selection criteria for secondary cytoreductive surgery (SCS) in recurrent ovarian cancer are yet to be defined. The aim of this study was to propose the selection criteria through identifying predictive factors for successful SCS. All patients who underwent SCS for recurrent epithelial ovarian, tubal, and peritoneal cancers between 1982 and 2012 at our institution were identified through our database. Potential prognostic factors were evaluated in univariate and multivariate analyses. Survival after SCS was examined by the grouping model based on the number of prognostic factors. We performed SCS in 80 consecutive patients, 48 (60%) of whom achieved complete resection. Complete/incomplete resection significantly influenced survival (median 65 vs. 26months; p=0.0005). Among favorable prognostic factors determined before SCS, treatment-free interval >12months, absent distant metastasis, solitary disease, and performance status 0 were independently associated with better survival (p=0.0009, 0.00003, 0.0004, and 0.015, respectively). Patients with 3-4 of those factors had better survival than those with 2 or 0-1 factors (median 79, 26, and 19months; p<0.00001 and <0.0000000001, respectively). Complete resection of visible tumors was achieved in 79% of patients with 3-4 factors, in 40% of those with 2 factors, and in 33% of those with 0-1 factor. Importantly, even when tumor removal was incomplete at SCS, median survival of patients with 3-4 factors was still quite favorable (83 vs. 67.5months for complete/incomplete resection, respectively), while those of patients with 2 factors (41 vs. 25months) and 0-1 factor (19 vs. 19months) were not. We strongly recommend SCS for patients with 3-4 of the above favorable factors at recurrence. As for patients with 2 factors, SCS may be considered if complete resection is expected to be achieved. Prospective studies are warranted to validate our proposal.