Chee Khoon Lee1, Sarah Lord2, Tami Grunewald3, Val Gebski2, Anne-Claire Hardy-Bessard4, Jalid Sehouli5, Kathrine Woie6, Mark Heywood7, Christian Schauer8, Ignace Vergote9, Giovanni Scambia10, Annamaria Ferrero11, Philipp Harter12, Eric Pujade-Lauraine13, Michael Friedlander14. 1. National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia; Cancer Care Centre, St George Hospital, Grey Street, Kogarah, NSW 2230, Australia. Electronic address: chee.lee@ctc.usyd.edu.au. 2. National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia. 3. Cancer Care Centre, St George Hospital, Grey Street, Kogarah, NSW 2230, Australia. 4. Clinique Armoricaine de Radiologie, 21 Rue du Vieux Séminaire, 22015 Saint-Brieuc Cedex, France. 5. Department of Gynecology, European Competence Center for Ovarian Cancer, Charité-University Medicine of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. 6. Department of Obstetrics and Gynecology, Haukeland University Hospital, N-5021 Bergen, Norway. 7. Vancouver Acute Department of Gynaecology, Rm 6207D Diamond Health Care Centre, 2775 Laurel St., Vancouver, BC V5Z 1M9, Canada. 8. Barmherzige Brüder Graz, Marschallgasse 12, 8020 Graz, Austria. 9. Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Leuven Cancer Institute, University Hospital Leuven, Herestraat 49, B-3000 Leuven, Belgium. 10. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy. 11. Academic Department Gynecologic Oncology, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy. 12. Department of Gynecology & Gynecologic Oncology, Klinikum Essen Mitte, Henricistrasse 92, 45136 Essen, Germany. 13. Université Paris Descartes, AP-HP, Hôpitaux Universitaires Paris Centre, Site Hôtel-Dieu, Oncologie, 1 Place du Parvis Notre-Dame, 75004 Paris, France. 14. Medical Oncology, Prince of Wales Hospital, Barker Street, Randwick, NSW 2013, Australia.
Abstract
OBJECTIVE: The role of secondary cytoreductive surgery (SCR) in platinum-sensitive recurrent ovarian cancer (ROC) remains controversial. The overall survival (OS) benefits for surgery reported in observational studies may be due to the selection of patients with better prognosis. METHODS: Using data from the CALYPSO trial, OS of patients who had SCR was compared to those treated with chemotherapy alone. Multivariate analyses were performed to adjust for prognostic factors. We also tested for an interaction between baseline prognostic groupings and the benefit of surgery. RESULTS: Of the 975 patients randomised in CALYPSO, 19% had SCR and 80% had chemotherapy alone. OS was longer for the SCR group than for chemotherapy alone (median, 49.9 vs. 29.7 months; adjusted hazard ratio (HR), 0.68; P = 0.004). For patients with SCR, the 3-year OS was 72% for those with no measurable disease, and 28% if residual tumour was larger than 5 cm. Patients with good prognostic features benefited the most from SCR (HR 0.43; P < 0.001). The benefit of SCR was less in patients with poorer prognostic features (test of trend P < 0.001). CONCLUSION: SCR was associated with improved OS in platinum-sensitive ROC, particularly in patients with favourable prognostic characteristics. However, these findings may be due to selection bias, and hence randomised trials are still essential.
RCT Entities:
OBJECTIVE: The role of secondary cytoreductive surgery (SCR) in platinum-sensitive recurrent ovarian cancer (ROC) remains controversial. The overall survival (OS) benefits for surgery reported in observational studies may be due to the selection of patients with better prognosis. METHODS: Using data from the CALYPSO trial, OS of patients who had SCR was compared to those treated with chemotherapy alone. Multivariate analyses were performed to adjust for prognostic factors. We also tested for an interaction between baseline prognostic groupings and the benefit of surgery. RESULTS: Of the 975 patients randomised in CALYPSO, 19% had SCR and 80% had chemotherapy alone. OS was longer for the SCR group than for chemotherapy alone (median, 49.9 vs. 29.7 months; adjusted hazard ratio (HR), 0.68; P = 0.004). For patients with SCR, the 3-year OS was 72% for those with no measurable disease, and 28% if residual tumour was larger than 5 cm. Patients with good prognostic features benefited the most from SCR (HR 0.43; P < 0.001). The benefit of SCR was less in patients with poorer prognostic features (test of trend P < 0.001). CONCLUSION: SCR was associated with improved OS in platinum-sensitive ROC, particularly in patients with favourable prognostic characteristics. However, these findings may be due to selection bias, and hence randomised trials are still essential.
Authors: P Harter; A du Bois; S Mahner; J Pfisterer; O Ortmann; C Marth; D Fink; F Hilpert; U Wagner; J Sehouli Journal: Geburtshilfe Frauenheilkd Date: 2016-02 Impact factor: 2.915
Authors: Robert L Coleman; Mark F Brady; Thomas J Herzog; Paul Sabbatini; Deborah K Armstrong; Joan L Walker; Byoung-Gie Kim; Keiichi Fujiwara; Krishnansu S Tewari; David M O'Malley; Susan A Davidson; Stephen C Rubin; Paul DiSilvestro; Karen Basen-Engquist; Helen Huang; John K Chan; Nick M Spirtos; Raheela Ashfaq; Robert S Mannel Journal: Lancet Oncol Date: 2017-04-21 Impact factor: 41.316