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Influence of Residual Tumor on Outcome in Ovarian Cancer Patients With FIGO Stage IV Disease

An Exploratory Analysis of the AGO-OVAR (Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group)

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

One of the most important prognostic factors in advanced ovarian cancer is the macroscopic absence of residual tumor after primary surgery. The impact of surgical outcome on the survival of patients with International Federation of Gynecology and Obstetrics (FIGO) stage IV disease is less clear and is the subject of this study.

Methods

Surgical and survival data were documented throughout the multicenter prospective randomized phase III trials of the AGO-OVAR (OVAR-3/-5/-7) and were used for this exploratory analysis. In these studies, 573 patients with FIGO stage IV disease were first operated, then randomized and homogenously treated with a combination therapy comprising the intravenous application of platinum and paclitaxel.

Results

The median progression-free survival and overall survival of patients with stage IV ovarian cancer were 12.6 and 26.1 months, respectively. Multivariable Cox regression analysis for overall survival revealed that residual tumor, mucinous histological type, multiple sites of metastases, and Eastern Cooperative Oncology Group performance status were statistically significant prognostic variables. Whereas patients with macroscopically complete resection had a statistically significant improved outcome, patients with residual disease of 0.1–1 cm and patients with residual tumor of >1 cm showed similar outcome.

Conclusions

Macroscopically complete resection in FIGO stage IV disease, irrespective of the site of distant tumor spread, is an important prognostic factor and the only prognosticator amenable to improvement by therapy. Our results suggest possible advantages of a reasonable attempt at complete cytoreduction even in FIGO stage IV disease. In addition, tumor biology could be an important factor for achieving complete resection.

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References

  1. Jemal A, Siegel R, Ward E, et al. Cancer statistics. CA Cancer J Clin. 2006;56:106–30.

    Article  PubMed  Google Scholar 

  2. Ferlay J, Autier P, Boniol M, et al. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol. 2007;18:581–92.

    Article  CAS  PubMed  Google Scholar 

  3. Du Bois A, Quinn M, Thigpen T, et al. 2004 consensus statements on the management of ovarian cancer: final document of the 3rd International Gynecologic Cancer Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004). Ann Oncol. 2005;16(Suppl 8):viii7–12.

    Google Scholar 

  4. International Federation of Gynecology and Obstetrics. Changing in definitions of clinical staging for carcinoma of the cervix and ovary. Am J Obstet Gynecol. 1987;156:263–4.

    Google Scholar 

  5. Curtin JP, Malik R, Venkatraman ES, et al. Stage IV ovarian cancer: impact of sugical debulking. Gynecol Oncol. 1997;64:9–12.

    Article  CAS  PubMed  Google Scholar 

  6. Akahira JI, Yoshikawa H, Shimizu Y, et al. Prognostic factors of stage IV epithelial ovarian cancer: a multicenter retrospective study. Gynecol Oncol. 2001;81:298–403.

    Article  Google Scholar 

  7. Bristow RE, Montz FJ, Lagasse LD, et al. Survival impact of surgical cytoreduction in stage IV epithelial ovarian cancer. Gynecol Oncol. 1999;72:278–87.

    Article  CAS  PubMed  Google Scholar 

  8. Repetto L, Chiara S, Pace M, et al. Prognostic factors in stage IV ovarian carcinoma treated with platinum-based regimens. Tumori. 1990;76:274–7.

    CAS  PubMed  Google Scholar 

  9. Heintz AP, Odicino F, Maisonneuve P, et al. Carcinoma of the ovary. FIGO 6th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet. 2006;95(Suppl 1):S161–92.

    Article  PubMed  Google Scholar 

  10. Winter WE III, Maxwell GL, Tian C, et al. Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2007;25:3621–7.

    Article  PubMed  Google Scholar 

  11. Bristow RE, Tomacruz RS, Armstrong DK, et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002;20:1248–59.

    Article  PubMed  Google Scholar 

  12. Eisenkop SM, Spirtos NM, Friedman RL, et al. Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with advanced ovarian cancer: a prospective study. Gynecol Oncol. 2003;90:390–6.

    Article  PubMed  Google Scholar 

  13. Goff BA, Matthews BJ, Larson EH, et al. Predictors of comprehensive surgical treatment in patients with ovarian cancer. Cancer. 2007;109:2031–42.

    Article  PubMed  Google Scholar 

  14. Earle CC, Schrag D, Neville BA, et al. Effect of surgeon specialty on processes of care and outcomes for ovarian cancer patients. J Natl Cancer Inst. 2006;98:172–80.

    PubMed  Google Scholar 

  15. Winter WE III, Maxell GL, Tian C, et al. Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2008;26:83–9.

    Article  PubMed  Google Scholar 

  16. Goodman HM, Harlow BL, Sheets EE, et al. The role of cytoreductive surgery in the management of stage IV epithelial ovarian carcinoma. Gynecol Oncol. 1992;46:367–71.

    Article  CAS  PubMed  Google Scholar 

  17. Liu PC, Benjamin I, Morgan MA, et al. Effect of surgical debulking on survival in stage IV ovarain cancer. Gynecol Oncol. 1997;64:4–8.

    Article  CAS  PubMed  Google Scholar 

  18. Munkarah AR, Hallum AV, Morris M, et al. Prognostic significance of residual disease in patients with stage IV epithelial ovarian cancer. Gynecol Oncol. 1997;64:13–7.

    Article  CAS  PubMed  Google Scholar 

  19. Du Bois A, Luck HJ, Meier W, et al. A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel a first-line treatment of ovarian cancer. J Natl Cancer Inst. 2003;95:1320–9.

    CAS  PubMed  Google Scholar 

  20. Du Bois A, Weber B, Rochon J, et al. Addition of epirubicin as a third drug to carboplatin-paclitaxel in first-line treatment of advanced ovarian cancer: a prospectively randomized gynecologic cancer intergroup trial by the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group and the Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens. J Clin Oncol. 2006;24:1127–35.

    Article  CAS  PubMed  Google Scholar 

  21. Pfisterer J, Weber B, Reuss A, et al. Randomized phase III rial to topotecan following carboplatin and paclitaxel in first-line treatment of advanced ovarian cancer: a gynecologic cancer intergroup trial of the AGO-OVAR and GINECO. J Natl Cancer Inst. 2006;98:1036–45.

    Article  CAS  PubMed  Google Scholar 

  22. Du Bois A, Reuss A, Pujade-Lauraine E, et al. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 mulitcenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe dÌnvestigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer. 2009;115:1234–44.

    Article  CAS  PubMed  Google Scholar 

  23. Benedet JL, Bender H, Jones H III, et al. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet. 2000;70:209–62.

    CAS  Google Scholar 

  24. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.

    Article  Google Scholar 

  25. Cox DR, Oakes D. Analysis of Survival Data. London, UK: Chapman and Hall; 1984.

    Google Scholar 

  26. Crawford SC, Vasex PA, Paul J, et al. Does aggressive surgery only benefit patients with less advanced ovarian cancer? Results from an international comparison within the SCOTROC-1 Trail. J Clin Oncol. 2005;23:8802–11.

    Article  PubMed  Google Scholar 

  27. Bristow RE, Eisenhauer EL, Santillan A, Chi DS. Delaying the primary surgical effort for advanced ovarian cancer: a systematic review of neoadjuvant chemotherapy and interval cytoreduction. Gynecol Oncol. 2007;104:480–90.

    Article  PubMed  Google Scholar 

  28. Kang S, Nam BH. Does neoadjuvant chemotherapy increase optimal cytoreduction rate in advanced ovaran cancer? Meta-analysis of 21 studies. Ann Surg Oncol. 2009:16:2315–20.

    Article  PubMed  Google Scholar 

  29. Vergote CG, Trope F, Amant GB, et al. EORTC-GCG/NCIC-CTG randomized trial comparing primary debulking surgery with neoadjuvant chemotherapy in stage IIIC–IV ovarian, fallopian tube and peritoneal cancer (abstract). Plenary presentation at the 12th Biennal meeting International Gynecologic Cancer Society IGCS, Bangkok, Thailand, October 25–28, 2008.

  30. Hess V, A’Hern R, Nasiri N, et al. Mucinous epithelial ovarian cancer: a separate entity requiring specific treatment. J Clin Oncol. 2004;22:1040–4.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

We appreciate the support of the study secretary, Gabriela Elser. We thank all patients and centers of the AGO and GINECO study groups participating in the underlying trials. The AGO-OVAR received grants for the phase III study AGO-OVAR 3 from Bristol-Myers-Squibb, for the AGO-OVAR 5 from Pfizer, and for AGO-OVAR 7 from Glaxo Smith Kline.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany

    Pauline Wimberger PhD, Michael Wehling MD & Rainer Kimmig PhD

  2. Institute for Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany

    Nils Lehmann PhD

  3. Department of Gynecology and Obstetrics, Technical University of Munich, Munich, Germany

    Barbara Schmalfeldt PhD

  4. Department of Gynecology and Obstetrics, University of Munich–Grosshadern, Grosshadern, Germany

    Alexander Burges MD

  5. Department of Gynecology and Gynecological Oncology, HSK Dr. Horst Schmidt Klinik Wiesbaden, Wiesbaden, Germany

    Philipp Harter MD & Andreas du Bois PhD

  6. Department of Gynecology and Obstetrics, Hospital of Solingen, Solingen, Germany

    Jacobus Pfisterer PhD

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  1. Pauline Wimberger PhD
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  2. Michael Wehling MD
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Correspondence to Pauline Wimberger PhD.

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Wimberger, P., Wehling, M., Lehmann, N. et al. Influence of Residual Tumor on Outcome in Ovarian Cancer Patients With FIGO Stage IV Disease. Ann Surg Oncol 17, 1642–1648 (2010). https://doi.org/10.1245/s10434-010-0964-9

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  • DOI: https://doi.org/10.1245/s10434-010-0964-9

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