Article

Annals of Surgical Oncology

, Volume 13, Issue 12, pp 1702-1710

First online:

Surgery in Recurrent Ovarian Cancer: The Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR Trial

  • Philipp HarterAffiliated withDepartment of Gynecology & Gynecologic Oncology, HSK, Dr. Horst Schmidt Klinik Wiesbaden Email author 
  • , Andreas du BoisAffiliated withDepartment of Gynecology & Gynecologic Oncology, HSK, Dr. Horst Schmidt Klinik Wiesbaden
  • , Maik HahmannAffiliated withCoordinating Center for Clinical Trials, Marburg University
  • , Annette HasenburgAffiliated withDepartment of Gynecology & Obstetrics, Freiburg University
  • , Alexander BurgesAffiliated withDepartment of Gynecology & Obstetrics, University of Muenchen - Grosshadern
  • , Sibylle LoiblAffiliated withDepartment of Gynecology & Obstetrics, Frankfurt University
  • , Martina GroppAffiliated withDepartment of Gynecology & Obstetrics, EVK Duesseldorf
  • , Jens HuoberAffiliated withDepartment of Gynecology & Obstetrics, Tuebingen University
  • , Daniel FinkAffiliated withDepartment of Gynecology & Obstetrics, Zuerich University
    • , Willibald SchröderAffiliated withDepartment of Gynecology & Obstetrics, Central Hospital Bremen
    • , Karsten MuenstedtAffiliated withDepartment of Gynecology & Obstetrics, Giessen University
    • , Barbara SchmalfeldtAffiliated withDepartment of Gynecology & Obstetrics, University of Muenchen r.d.I.
    • , Guenter EmonsAffiliated withDepartment of Gynecology & Obstetrics, Goettingen University
    • , Jacobus PfistererAffiliated withDepartment of Gynecology & Obstetrics, Universitätsklinikum Schleswig-Holstein Campus Kiel
    • , Kerstin WollschlaegerAffiliated withDepartment of Gynecology & Obstetrics, Magdeburg University
    • , Hans-Gerd MeerpohlAffiliated withDepartment of Gynecology & Obstetrics, St. Vincentius Hospital Karlsruhe
    • , Georg-Peter BreitbachAffiliated withDepartment of Gynecology & Obstetrics, City Hospital Neunkirchen
    • , Berno TannerAffiliated withDepartment of Gynecology & Obstetrics, Mainz University
    • , Jalid SehouliAffiliated withDepartment of Gynecology & Obstetrics, Berlin University Charite

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Abstract

Background

The role of cytoreductive surgery in relapsed ovarian cancer is not clearly defined. Therefore, patient selection remains arbitrary and depends on the center’s preference rather than on established selection criteria. The Descriptive Evaluation of preoperative Selection KriTeria for OPerability in recurrent OVARian cancer (DESKTOP OVAR) trial was undertaken to form a hypothesis for a panel of criteria for selecting patients who might benefit from surgery in relapsed ovarian cancer.

Methods

The DESKTOP trial was an exploratory study based on data from a retrospective analysis of hospital records. Twenty-five member institutions of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee (AGO OC) and AGO-OVAR boards collected data on their patients with cytoreductive surgery for relapsed invasive epithelial ovarian cancer performed in 2000–2003.

Results

Two hundred and sixty-seven patients were included. Complete resection was associated with significantly longer survival compared with surgery leaving any postoperative residuals [median 45.2 vs. 19.7 months; hazard ratio (HR) 3.71; 95% confidence interval (CI) 2.27–6.05; P < .0001]. Variables associated with complete resection were performance status (PS) [Eastern Cooperative Oncology Group (ECOG) 0 vs. > 0; P < .001], International Federation of Gynecology and Obstetrics (FIGO) stage at initial diagnosis (FIGO I/II vs. III/IV, P = .036), residual tumor after primary surgery (none vs. present, P <.001), and absence of ascites > 500 ml (P < .001). A combination of PS, early FIGO stage initially or no residual tumor after first surgery, and absence of ascites could predict complete resection in 79% of patients.

Conclusions

Only complete resection was associated with prolonged survival in recurrent ovarian cancer. The identified criteria panel will be verified in a prospective trial (AGO-DESKTOP II) evaluating whether it will render a useful tool for selecting the right patients for cytoreductive surgery in recurrent ovarian cancer.

Keywords

Ovarian cancer Ovarian neoplasm Recurrence Secondary cytoreductive surgery