Korean J Gynecol Oncol.  2008 Mar;19(1):75-80. 10.3802/kjgo.2008.19.1.75.

Clinical analysis for the prognostic factors in patients with recurrent epithelial ovarian cancer who underwent secondary cytoreductive surgery

• Kim HS
• Kim TH
• Chung HH
• Kim JW
• Park NH
• Song YS
• Kang SB

• KMID: 1979504
• DOI: http://doi.org/10.3802/kjgo.2008.19.1.75

Abstract

OBJECTIVE
To identify clinical prognostic factor improving survival of recurrent epithelial ovarian cancer (EOC) patients treated with secondary cytoreductive surgery (SCS).
METHODS
The indications of SCS were as follows; 1) complete response (CR) after primary cytoreductive surgery and adjuvant chemotherapy, 2) disease-free survival (DFS) (> or =6 months). Clinical data of 17 patients including age, DFS, peritoneal seeding identified during SCS, the number of recurrent tumors (> or =1 cm), serum CA-125 levels and maximal diameter of residual tumor after SCS were reviewed retrospectively between January 1990 and March 2007. Survival analyses were performed using Kaplan-Meier method with log-rank test and univariate Cox's regression analysis.
RESULTS
Mean age of them was 51.7 years. No peritoneal seeding identified during SCS was a prognostic factor improving progression-free survival after SCS (PFS-SCS) (30 vs. 6 months, p<.01 hazard ratio 0.099, 95% confidence interval 0.011-0.929, p=.043). Furthermore, serum CA-125 level (< or =37 U/ml) after SCS was a significant prognostic factors improving overall survival (51 vs. 19 months, p=.033; hazard ratio 0.212, 95% confidence interval 0.045-0.983, p=.045).
CONCLUSION
Serum CA-125 levels with normal value after SCS and no peritoneal seeding may be associated with the improvement of survival in recurrent epithelial ovarian cancer patients treated with SCS.

Keyword

Secondary cytoreductive surgery; Prognostic factor; Recurrent; Epithelial ovarian cancer

MeSH Terms

Chemotherapy, Adjuvant
Disease-Free Survival
Humans
Neoplasm, Residual
Neoplasms, Glandular and Epithelial
Ovarian Neoplasms
Reference Values
Retrospective Studies
Seeds
Neoplasms, Glandular and Epithelial
Ovarian Neoplasms

Figure

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  Fig. 1 Kaplan-Meier survival analysis with log-rank test for progression-free survival after secondary cytoreductive surgery (PFS-SCS) according to peritoneal seeding identified during secondary cytoreductive surgery (30 vs. 6 months, p=.0089).

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  Fig. 2 Kaplan-Meier survival analysis with log-rank test for overall survival (OS) according to serum CA-125 levels after secondary cytoreductive surgery (51 vs. 19 months, p=.033).

Reference

1. 2002 Annual Report of the Korea Central Cancer Registry. Last accessed: November 18, 2007. Available at: http://www.ncc.re.kr/index.jsp.

2. Chung HH, Hwang SY, Jung KW, Won YJ, Shin HR, Kim JW, et al. Ovarian cancer incidence and survival in Korea: 1993-2002. Int J Gynecol Cancer. 2007. 17:595–600.

3. Munkarah AR, Coleman RL. Critical evaluation of secondary cytoreduction in recurrent ovarian cancer. Gynecol Oncol. 2004. 95:273–280.

4. du Bois A, Luck HJ, Meier W, Adams HP, Mobus V, Costa S, et al. A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. J Natl Cancer Inst. 2003. 95:1320–1329.

5. Ozols RF, Bundy BN, Greer BE, Fowler JM, Clarke-Pearson D, Burger RA, et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: A Gynecologic Oncology Group study. J Clin Oncol. 2003. 21:3194–3200.

6. Polverino G, Parazzini F, Stellato G, Scarfone G, Cipriani S, Bolis G. Survival and prognostic factors of women with advanced ovarian cancer and complete response after a carboplatin-paclitaxel chemotherapy. Gynecol Oncol. 2005. 99:343–347.

7. Scarabelli C, Gallo A, Garbone A. Secondary cytoreductive surgery for patients with recurrent epithelial ovarian carcinoma. Gynecol Oncol. 2001. 83:504–512.

8. Tay E, Grant PT, Gebski V, Hacker NF. Secondary cytoreductive surgery for recurrent epithelial ovarian cancer. Obstet Gynecol. 2002. 99:1008–1013.

9. Uzan C, Morice P, Rey A, Pautier P, Camatte S, Lhomme C, et al. Outcomes after combined therapy including surgical resection in patients with epithelial ovarian cancer recurrence(s) exclusively in lymph nodes. Ann Surg Oncol. 2004. 11:658–664.

10. Tebes SJ, Sayer RA, Palmer JM, Tebes CC, Martino MA, Hoffman MS. Cytoreductive surgery for patients with recurrent epithelial ovarian carcinoma. Gynecol Oncol. 2007. 106:482–487.

11. Santillan A, Karam AK, Li AJ, Giuntoli R 2nd, Gardner GJ, Cass I, et al. Secondary cytoreductive surgery for isolated nodal recurrence in patients with epithelial ovarian cancer. Gynecol Oncol. 2007. 104:686–690.

12. Benedetii Panici P, De vivo A, Bellati F, Manci N, Perniola G, Basile S, et al. Secondary cytoreductive surgery in patients with platinum-sensitive recurrent ovarian cancer. Ann Surg Oncol. 2007. 14:1136–1142.

13. Chi DS, McCaughty K, Diaz JP, Huh J, Schwabenbauer S, Hummer AJ, et al. Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent, platinum-sensitive epithelial ovarian carcinoma. Cancer. 2006. 106:1933–1939.

14. Salani R, Santillan A, Zahurak ML, Giuntoli RL 2nd, Garder GJ, Amstrong DK, et al. Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer: Analysis of prognostic factors and survival outcome. Cancer. 2007. 109:685–691.

15. Onda T, Yoshikawa H, Yasugi T, Yamada M, Matsumoto K, Taketani Y. Seconadry cytoreductive surgery for recurrent epithelial ovarian carcinoma proposal for patients selection. Br J Cancer. 2005. 92:1026–1032.

16. Meier W, Stieber P, Hasholzner U, Gropp M, Fateh-Moghadam A. Prognostic significance of CA 125 in patients with ovarian cancer and secondary debulking surgery. Anticancer Res. 1997. 17:2945–2947.

17. Zang RY, Li ZT, Tang J, Cheng X, Cai SM, Zhang ZY, et al. Secondary cytoreductive surgery for patients with relapsed epithelial ovarian carcinoma: who benefits? Cancer. 2004. 100:1152–1161.

18. Zanon C, Clara R, Chiappino I, Bortolini M, Cornaglia S, Simone P, et al. Cytoreductive surgery and intraperitoenal chemohyperthermia for recurrent peritoneal carcionomatosis from ovarian cancer. World J Surg. 2004. 28:1040–1045.

19. Gadducci A, Cosio S, Zola P, Landoni F, Maggino T, Sartori E. Surveillance procedures for patients treated for epithelial ovarian cancer: A review of the literature. Int J Gynecol Cancer. 2007. 17:21–31.

20. Leitao MM Jr, Kardos S, Barakat RR, Chi DS. Tertiary cytoreduction in patients with recurrent ovarian carcinoma. Gynecol Oncol. 2004. 95:181–188.