Secondary cytoreductive surgery for recurrent ovarian cancer: who will get the most benefit?

Abstract

<h3>Objectives:</h3> Indications for secondary cytoreductive surgery (CRS) in ovarian cancer is often dependent on the multiple confounding factors. We aimed to evaluate the treatment outcomes of recurrent ovarian cancer and investigated the factors identifying patients who most likely benefit from the surgery. <h3>Methods:</h3> We retrospectively reviewed medical records of patients with recurrent ovarian cancer from 2002 to 2020. Treatment outcomes and potential factors for survival were evaluated between the chemotherapy and surgery groups. <h3>Results:</h3> A total of 262 patients with recurrent ovarian cancer were identified. The patient's median age was 53 (20-80) and 87.4% of patients had initial stage III/IV disease. Of all patient, 89 (34%) patients received 2nd CRS for the disease recurrence. The median survival was 41.0 months (95% CI, 37.4-44.5) and 88 months (95% CI, 64.2-111.7 months) in the chemotherapy and surgery groups, respectively. Patients received the 2nd CRS were more likely to be young and had no gross residual disease at primary surgery, <i>BRCA1/2</i> mutation, limited metastatic lesion, and low rate of ascites (P=0.001, 0.001, 0.001, 0.001, 0.04 respectively). In multivariate analysis Age (P=0.010), limited lesion (P=0.029), and progression-free interval (PFI) >12months (P=0.001) were significant prognostic factors for survival. The positive predictive value of criteria consisted of the significant prognostic factors in predicting optimal tumor resection was 100% and 80% with single regional recurrence and limited carcinomatosis in patients with good prognostic factors. <h3>Conclusions:</h3> Secondary CRS showed a significant survival impact in a well-selected patient population. Good performance status, PFI (>12 months) and limited lesions (single region or ≥2 regions with limited carcinomatosis) can be considered as simplified criteria for secondary CRS in recurrent ovarian cancer.