Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer: Analysis of prognostic factors and survival outcome

Ritu Salani, Antonio Santillan-Gomez, Marianna L. Zahurak, Robert L. Giuntoli, Ginger J. Gardner, Deborah Kay Armstrong, Robert E. Bristow

Research output: Contribution to journalArticle

Abstract

BACKGROUND. The objective of this study was to evaluate the role of secondary cytoreductive surgery in the outcome of patients who had recurrent epithelial ovarian carcinoma that was limited to ≤5 recurrence sites within the abdomen or pelvis on preoperative imaging studies and attempt to define selection criteria associated with improved survival, with specific attention to the number of lesions suspicious for recurrent disease. METHODS. Patients who underwent secondary surgical cytoreduction for recurrent epithelial ovarian cancer between September 1997 and March 2005 were identified retrospectively from tumor registry databases. Study inclusion criteria required a complete clinical response to primary therapy, ≥12 months between initial diagnosis and recurrence, and ≤5 recurrence sites on preoperative imaging studies. Univariate and multivariate logistic regression analyses were used to evaluate the effect of clinicopathologic variables on overall postrecurrence survival. RESULTS. Fifty-five patients met the study inclusion criteria. The median patient age at recurrence was 57.7 years, and the median diagnosis-to-recurrence interval was 32 months (range, 12-164 months). Complete cytoreduction was achieved in 41 patients (74.5%). On multivariate analysis, the statistically significant and independent predictors of overall survival were a diagnosis-to-recurrence interval ≥18 months (median survival, 49 months vs 3 months; P <.01), the number of radiographic recurrence sites (median survival, 50 months for patients with 1 or 2 sites vs 12 months for patients with 3 to 5 sites; P <.03), and residual disease (median survival, 50 months for patients with no macroscopic residual disease vs 7.2 months for patients with macroscopic residual disease; P <.01). Age, tumor grade, histology, CA-125 level, ascites, and tumor size were not associated significantly with survival. CONCLUSIONS. The current data supported the definition of localized recurrent ovarian cancer as patients with 1 or 2 radiographic recurrence sites. In this select population, a diagnosis-to-recurrence interval ≥18 months and complete secondary surgical cytoreduction, which was achievable in the majority of patients, were associated with a median postrecurrence survival of approximately 50 months.

Original languageEnglish (US)
Pages (from-to)685-691
Number of pages7
JournalCancer
Volume109
Issue number4
DOIs
StatePublished - Feb 15 2007

Fingerprint

Survival Analysis
Recurrence
Survival
Ovarian epithelial cancer
Neoplasms
Pelvis
Ascites
Abdomen
Ovarian Neoplasms
Patient Selection
Registries
Histology
Multivariate Analysis
Logistic Models
Regression Analysis
Databases
Carcinoma

Keywords

  • Diagnosis-to-recurrence interval
  • Localized recurrence
  • Ovarian carcinoma
  • Residual disease
  • Secondary cytoreductive surgery

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer : Analysis of prognostic factors and survival outcome. / Salani, Ritu; Santillan-Gomez, Antonio; Zahurak, Marianna L.; Giuntoli, Robert L.; Gardner, Ginger J.; Armstrong, Deborah Kay; Bristow, Robert E.

In: Cancer, Vol. 109, No. 4, 15.02.2007, p. 685-691.

Research output: Contribution to journalArticle

Salani, Ritu ; Santillan-Gomez, Antonio ; Zahurak, Marianna L. ; Giuntoli, Robert L. ; Gardner, Ginger J. ; Armstrong, Deborah Kay ; Bristow, Robert E. / Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer : Analysis of prognostic factors and survival outcome. In: Cancer. 2007 ; Vol. 109, No. 4. pp. 685-691.
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abstract = "BACKGROUND. The objective of this study was to evaluate the role of secondary cytoreductive surgery in the outcome of patients who had recurrent epithelial ovarian carcinoma that was limited to ≤5 recurrence sites within the abdomen or pelvis on preoperative imaging studies and attempt to define selection criteria associated with improved survival, with specific attention to the number of lesions suspicious for recurrent disease. METHODS. Patients who underwent secondary surgical cytoreduction for recurrent epithelial ovarian cancer between September 1997 and March 2005 were identified retrospectively from tumor registry databases. Study inclusion criteria required a complete clinical response to primary therapy, ≥12 months between initial diagnosis and recurrence, and ≤5 recurrence sites on preoperative imaging studies. Univariate and multivariate logistic regression analyses were used to evaluate the effect of clinicopathologic variables on overall postrecurrence survival. RESULTS. Fifty-five patients met the study inclusion criteria. The median patient age at recurrence was 57.7 years, and the median diagnosis-to-recurrence interval was 32 months (range, 12-164 months). Complete cytoreduction was achieved in 41 patients (74.5{\%}). On multivariate analysis, the statistically significant and independent predictors of overall survival were a diagnosis-to-recurrence interval ≥18 months (median survival, 49 months vs 3 months; P <.01), the number of radiographic recurrence sites (median survival, 50 months for patients with 1 or 2 sites vs 12 months for patients with 3 to 5 sites; P <.03), and residual disease (median survival, 50 months for patients with no macroscopic residual disease vs 7.2 months for patients with macroscopic residual disease; P <.01). Age, tumor grade, histology, CA-125 level, ascites, and tumor size were not associated significantly with survival. CONCLUSIONS. The current data supported the definition of localized recurrent ovarian cancer as patients with 1 or 2 radiographic recurrence sites. In this select population, a diagnosis-to-recurrence interval ≥18 months and complete secondary surgical cytoreduction, which was achievable in the majority of patients, were associated with a median postrecurrence survival of approximately 50 months.",
keywords = "Diagnosis-to-recurrence interval, Localized recurrence, Ovarian carcinoma, Residual disease, Secondary cytoreductive surgery",
author = "Ritu Salani and Antonio Santillan-Gomez and Zahurak, {Marianna L.} and Giuntoli, {Robert L.} and Gardner, {Ginger J.} and Armstrong, {Deborah Kay} and Bristow, {Robert E.}",
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T1 - Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer

T2 - Analysis of prognostic factors and survival outcome

AU - Salani, Ritu

AU - Santillan-Gomez, Antonio

AU - Zahurak, Marianna L.

AU - Giuntoli, Robert L.

AU - Gardner, Ginger J.

AU - Armstrong, Deborah Kay

AU - Bristow, Robert E.

PY - 2007/2/15

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N2 - BACKGROUND. The objective of this study was to evaluate the role of secondary cytoreductive surgery in the outcome of patients who had recurrent epithelial ovarian carcinoma that was limited to ≤5 recurrence sites within the abdomen or pelvis on preoperative imaging studies and attempt to define selection criteria associated with improved survival, with specific attention to the number of lesions suspicious for recurrent disease. METHODS. Patients who underwent secondary surgical cytoreduction for recurrent epithelial ovarian cancer between September 1997 and March 2005 were identified retrospectively from tumor registry databases. Study inclusion criteria required a complete clinical response to primary therapy, ≥12 months between initial diagnosis and recurrence, and ≤5 recurrence sites on preoperative imaging studies. Univariate and multivariate logistic regression analyses were used to evaluate the effect of clinicopathologic variables on overall postrecurrence survival. RESULTS. Fifty-five patients met the study inclusion criteria. The median patient age at recurrence was 57.7 years, and the median diagnosis-to-recurrence interval was 32 months (range, 12-164 months). Complete cytoreduction was achieved in 41 patients (74.5%). On multivariate analysis, the statistically significant and independent predictors of overall survival were a diagnosis-to-recurrence interval ≥18 months (median survival, 49 months vs 3 months; P <.01), the number of radiographic recurrence sites (median survival, 50 months for patients with 1 or 2 sites vs 12 months for patients with 3 to 5 sites; P <.03), and residual disease (median survival, 50 months for patients with no macroscopic residual disease vs 7.2 months for patients with macroscopic residual disease; P <.01). Age, tumor grade, histology, CA-125 level, ascites, and tumor size were not associated significantly with survival. CONCLUSIONS. The current data supported the definition of localized recurrent ovarian cancer as patients with 1 or 2 radiographic recurrence sites. In this select population, a diagnosis-to-recurrence interval ≥18 months and complete secondary surgical cytoreduction, which was achievable in the majority of patients, were associated with a median postrecurrence survival of approximately 50 months.

AB - BACKGROUND. The objective of this study was to evaluate the role of secondary cytoreductive surgery in the outcome of patients who had recurrent epithelial ovarian carcinoma that was limited to ≤5 recurrence sites within the abdomen or pelvis on preoperative imaging studies and attempt to define selection criteria associated with improved survival, with specific attention to the number of lesions suspicious for recurrent disease. METHODS. Patients who underwent secondary surgical cytoreduction for recurrent epithelial ovarian cancer between September 1997 and March 2005 were identified retrospectively from tumor registry databases. Study inclusion criteria required a complete clinical response to primary therapy, ≥12 months between initial diagnosis and recurrence, and ≤5 recurrence sites on preoperative imaging studies. Univariate and multivariate logistic regression analyses were used to evaluate the effect of clinicopathologic variables on overall postrecurrence survival. RESULTS. Fifty-five patients met the study inclusion criteria. The median patient age at recurrence was 57.7 years, and the median diagnosis-to-recurrence interval was 32 months (range, 12-164 months). Complete cytoreduction was achieved in 41 patients (74.5%). On multivariate analysis, the statistically significant and independent predictors of overall survival were a diagnosis-to-recurrence interval ≥18 months (median survival, 49 months vs 3 months; P <.01), the number of radiographic recurrence sites (median survival, 50 months for patients with 1 or 2 sites vs 12 months for patients with 3 to 5 sites; P <.03), and residual disease (median survival, 50 months for patients with no macroscopic residual disease vs 7.2 months for patients with macroscopic residual disease; P <.01). Age, tumor grade, histology, CA-125 level, ascites, and tumor size were not associated significantly with survival. CONCLUSIONS. The current data supported the definition of localized recurrent ovarian cancer as patients with 1 or 2 radiographic recurrence sites. In this select population, a diagnosis-to-recurrence interval ≥18 months and complete secondary surgical cytoreduction, which was achievable in the majority of patients, were associated with a median postrecurrence survival of approximately 50 months.

KW - Diagnosis-to-recurrence interval

KW - Localized recurrence

KW - Ovarian carcinoma

KW - Residual disease

KW - Secondary cytoreductive surgery

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