Survival impact of complete cytoreductive surgery in the primary management of FIGO stage IIIC, high-grade, epithelial ovarian cancer

Abstract

16551 Background: To evaluate the influence of complete primary surgical cytoreduction and other prognostic variables on overall survival among patients with FIGO stage IIIC, high grade, epithelial ovarian cancer. Methods: Ninety-three consecutive patients undergoing primary cytoreductive surgery for FIGO-stage IIIC high-grade epithelial ovarian carcinoma between 1997 and 2005 were retrospectively identified from the tumor registry database. Clinical data were abstracted from the medical record: age, ASA, presence of ascites, presence of carcinomatosis, residual disease, use of radical procedures, pre-operative serum albumin, and pre-operative serum CA-125. Survival estimates were calculated using the Kaplan and Meier method. Univariate and multivariate regression analyses were used was used to identify independent variables associated with improved survival. Fisher exact test was used for proportion variables. Results: The median age was 62 years (range=37 to 83 years), and 96% of patients had serous histology. Carcinomatosis was present in 80.4 % of patients. All patients received platinum based chemotherapy following primary surgery. The median follow-up time was 27 months (range=1 to 124 months). Radical procedures were used in 59% of all patients. The overall rate of significant morbidity associated with primary cytoreductive surgery was 25%. Optimal cytoreduction (residual ≤ l cm) was achieved in 78/93 patients (83.8%). Complete cytoreduction (no gross residual) was achieved in 43/93 patients (46.2%) and was associated with a median survival of 58.4 months, compared to 30.1 months for patients with residual disease 0.1-l.0 cm and 24.4 months for patients with suboptimal residual disease (p= 0.005). Residual disease was the only significant and independent predictor of survival (adjusted hazard ratio (AHR) =2.35, p=0.0002). Conclusions: Numerous clinical variables have been reported to have prognostic value in advanced ovarian carcinoma. When all patients receive platinum-based chemotherapy post-operatively, the only statistically significant and independent predictor of overall survival is diameter of the largest residual tumor among patients with large-volume, high-grade ovarian cancer. No significant financial relationships to disclose.