BACKGROUND: The value of surgery for recurrent epithelial ovarian cancer (OC) is controversial. The aim of the present study was to evaluate the outcome of EOC-patients who underwent tertiary cytoreductive surgery (TCS) and to identify prognostic markers for complete tumor resection and survival. METHODS: Retrospective multicenter evaluation of TCS patients treated between 1997 and 2011 in 14 centers across Europe, the United States, and Asia. RESULTS: We evaluated 406 patients (median age, 55 years; range, 16-80 years). Median time from first to second recurrence was 18 months (2-204 months). Median follow-up from TCS was 14 months (0-182 months), and median OS was 26 months (95 % CI, 19.62-32.38 months). Median OS for patients without versus any tumor residuals was 49 months (95 % CI, 42.5-56.4 months) versus 12 months (95 % CI 9.3-14.7 months) (p < 0.001). The majority of the patients had an advanced initial FIGO stage III/IV (69 %), peritoneal carcinomatosis (51.7 %), and absence of ascites (72.2 %). A total of 224 patients (54.1 %) underwent complete tumor resection. The most frequent tumor dissemination site was the pelvis (73 %). Rates of major operative morbidity and 30-day mortality were 25.9 % and 3.2 %, respectively. Multivariate analysis identified platinum resistance, tumor residuals at secondary surgery, and peritoneal carcinomatosis to be of predictive significance for complete tumor resection, while tumor residuals at secondary and tertiary surgery, decreasing interval to second relapse, ascites, upper abdominal tumor involvement, and nonplatinum third-line chemotherapy significantly affected OS. CONCLUSIONS: In this largest known database for TCS, residual tumor retains its high impact on survival even in the tertiary setting of OC. In specialized centers high rates of complete tumor resection can be obtained. Prospective analyses are warranted to define the value of TCS in EOC.
BACKGROUND: The value of surgery for recurrent epithelial ovarian cancer (OC) is controversial. The aim of the present study was to evaluate the outcome of EOC-patients who underwent tertiary cytoreductive surgery (TCS) and to identify prognostic markers for complete tumor resection and survival. METHODS: Retrospective multicenter evaluation of TCSpatients treated between 1997 and 2011 in 14 centers across Europe, the United States, and Asia. RESULTS: We evaluated 406 patients (median age, 55 years; range, 16-80 years). Median time from first to second recurrence was 18 months (2-204 months). Median follow-up from TCS was 14 months (0-182 months), and median OS was 26 months (95 % CI, 19.62-32.38 months). Median OS for patients without versus any tumor residuals was 49 months (95 % CI, 42.5-56.4 months) versus 12 months (95 % CI 9.3-14.7 months) (p < 0.001). The majority of the patients had an advanced initial FIGO stage III/IV (69 %), peritoneal carcinomatosis (51.7 %), and absence of ascites (72.2 %). A total of 224 patients (54.1 %) underwent complete tumor resection. The most frequent tumor dissemination site was the pelvis (73 %). Rates of major operative morbidity and 30-day mortality were 25.9 % and 3.2 %, respectively. Multivariate analysis identified platinum resistance, tumor residuals at secondary surgery, and peritoneal carcinomatosis to be of predictive significance for complete tumor resection, while tumor residuals at secondary and tertiary surgery, decreasing interval to second relapse, ascites, upper abdominal tumor involvement, and nonplatinum third-line chemotherapy significantly affected OS. CONCLUSIONS: In this largest known database for TCS, residual tumor retains its high impact on survival even in the tertiary setting of OC. In specialized centers high rates of complete tumor resection can be obtained. Prospective analyses are warranted to define the value of TCS in EOC.
Authors: P Harter; S Mahner; F Hilpert; I Runnebaum; O Ortmann; A Mustea; J Sehouli; A du Bois; U Wagner Journal: Geburtshilfe Frauenheilkd Date: 2013-03 Impact factor: 2.915
Authors: David D Bowtell; Steffen Böhm; Ahmed A Ahmed; Paul-Joseph Aspuria; Robert C Bast; Valerie Beral; Jonathan S Berek; Michael J Birrer; Sarah Blagden; Michael A Bookman; James D Brenton; Katherine B Chiappinelli; Filipe Correia Martins; George Coukos; Ronny Drapkin; Richard Edmondson; Christina Fotopoulou; Hani Gabra; Jérôme Galon; Charlie Gourley; Valerie Heong; David G Huntsman; Marcin Iwanicki; Beth Y Karlan; Allyson Kaye; Ernst Lengyel; Douglas A Levine; Karen H Lu; Iain A McNeish; Usha Menon; Steven A Narod; Brad H Nelson; Kenneth P Nephew; Paul Pharoah; Daniel J Powell; Pilar Ramos; Iris L Romero; Clare L Scott; Anil K Sood; Euan A Stronach; Frances R Balkwill Journal: Nat Rev Cancer Date: 2015-11 Impact factor: 60.716
Authors: Angelo Di Giorgio; Pierandrea De Iaco; Michele De Simone; Alfredo Garofalo; Giovanni Scambia; Antonio Daniele Pinna; Giorgio Maria Verdecchia; Luca Ansaloni; Antonio Macrì; Paolo Cappellini; Valerio Ceriani; Giorgio Giorda; Daniele Biacchi; Marco Vaira; Mario Valle; Paolo Sammartino Journal: Ann Surg Oncol Date: 2016-11-28 Impact factor: 5.344
Authors: C Fotopoulou; K Savvatis; P Kosian; I E Braicu; G Papanikolaou; K Pietzner; S-C Schmidt; J Sehouli Journal: Br J Cancer Date: 2013-01-15 Impact factor: 7.640
Authors: Beryl L Manning-Geist; Dennis S Chi; Kara Long Roche; Oliver Zivanovic; Yukio Sonoda; Ginger J Gardner; Roisin E O'Cearbhaill; Nadeem R Abu-Rustum; Mario M Leitao Journal: Gynecol Oncol Date: 2021-05-25 Impact factor: 5.304
Authors: Candace M Howard; Nadim Bou Zgheib; Stephen Bush; Timothy DeEulis; Antonio Cortese; Antonio Mollo; Seth T Lirette; Krista Denning; Jagan Valluri; Pier Paolo Claudio Journal: Transl Oncol Date: 2020-08-28 Impact factor: 4.243