J Gynecol Oncol.  2019 Nov;30(6):e100. 10.3802/jgo.2019.30.e100.

The efficacy of secondary cytoreductive surgery for recurrent ovarian, tubal, or peritoneal cancer in Tian-model low-risk patients

• So M
• Miyamoto T
• Murakami R
• Abiko K
• Hamanishi
• Baba T
• Mandai M

• KMID: 2458903
• DOI: http://doi.org/10.3802/jgo.2019.30.e100

Abstract

OBJECTIVE
In patients with recurrent ovarian cancer (ROC) in whom surgery is likely to render them disease-free, it is unclear whether secondary cytoreductive surgery (SCS) combined with chemotherapy is superior to chemotherapy alone. The aim of this study was to evaluate the 2 treatment options in Tian-model low-risk patients.
METHODS
We retrospectively reviewed 118 ROC cases treated in our hospital between 2004 and 2016. Of these, 52 platinum-sensitive cases were classified as low-risk (complete resection anticipated) using the Tian model. Prognostic factors were assessed with univariate and multivariate analysis using Cox's regression model. Progression-free survival (PFS) and overall survival (OS) were compared in patients treated with SCS plus chemotherapy (SCS group) and those treated with chemotherapy alone (chemotherapy group), using a propensity-score-based matching method.
RESULTS
By multivariate analysis, the only factor associated with better OS was SCS. PFS and OS were significantly longer in the SCS group compared to the chemotherapy group in the matched cohort (median PFS: 21.7 vs. 15.1 months, p=0.027 and median OS: 91.4 vs. 33.4 months, p=0.008, respectively). In cases with multiple-site recurrence, the SCS group also showed significantly longer OS than the chemotherapy group (median 91.4 vs. 34.8 months, p=0.022). In almost all SCS cases, cooperation was required from other departments, and operation time was lengthy (median 323 minutes); however, no serious complications occurred.
CONCLUSION
SCS combined with chemotherapy results in better PFS and OS than chemotherapy alone in first platinum-sensitive ROC patients categorized as low-risk by Tian's model.

Keyword

Carcinoma, Ovarian Epithelial; Recurrence; Cytoreduction Surgical Procedures; Chemotherapy; Tian Model

MeSH Terms

Cohort Studies
Cytoreduction Surgical Procedures
Disease-Free Survival
Drug Therapy
Humans
Methods
Multivariate Analysis
Ovarian Neoplasms
Recurrence
Retrospective Studies