Advertisement

International Journal of Clinical Oncology

, Volume 21, Issue 3, pp 573–579 | Cite as

Proposal for selection criteria of secondary cytoreductive surgery in recurrent epithelial ovarian, tubal, and peritoneal cancers

  • Takeo MinaguchiEmail author
  • Toyomi Satoh
  • Koji Matsumoto
  • Manabu Sakurai
  • Hiroyuki Ochi
  • Mamiko Onuki
  • Akinori Oki
  • Hiroyuki Yoshikawa
Original Article

Abstract

Background

The selection criteria for secondary cytoreductive surgery (SCS) in recurrent ovarian cancer are yet to be defined. The aim of this study was to propose the selection criteria through identifying predictive factors for successful SCS.

Methods

All patients who underwent SCS for recurrent epithelial ovarian, tubal, and peritoneal cancers between 1982 and 2012 at our institution were identified through our database. Potential prognostic factors were evaluated in univariate and multivariate analyses. Survival after SCS was examined by the grouping model based on the number of prognostic factors.

Results

We performed SCS in 80 consecutive patients, 48 (60 %) of whom achieved complete resection. Complete/incomplete resection significantly influenced survival (median 65 vs. 26 months; p = 0.0005). Among favorable prognostic factors determined before SCS, treatment-free interval >12 months, absent distant metastasis, solitary disease, and performance status 0 were independently associated with better survival (p = 0.0009, 0.00003, 0.0004, and 0.015, respectively). Patients with 3–4 of those factors had better survival than those with 2 or 0–1 factors (median 79, 26, and 19 months; p < 0.00001 and <0.0000000001, respectively). Complete resection of visible tumors was achieved in 79 % of patients with 3–4 factors, in 40 % of those with 2 factors, and in 33 % of those with 0–1 factor. Importantly, even when tumor removal was incomplete at SCS, median survival of patients with 3–4 factors was still quite favorable (83 vs. 67.5 months for complete/incomplete resection, respectively), while those of patients with 2 factors (41 vs. 25 months) and 0–1 factor (19 vs. 19 months) were not.

Conclusion

We strongly recommend SCS for patients with 3–4 of the above favorable factors at recurrence. As for patients with 2 factors, SCS may be considered if complete resection is expected to be achieved. Prospective studies are warranted to validate our proposal.

Keywords

Secondary cytoreductive surgery Recurrence Ovarian cancer Tubal cancer Peritoneal cancer Survival 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Stuart GC, Kitchener H, Bacon M et al (2011) 2010 Gynecologic Cancer Inter Group (GCIG) consensus statement on clinical trials in ovarian cancer: report from the fourth ovarian cancer consensus conference. Int J Gynecol Cancer 21:750–755CrossRefPubMedGoogle Scholar
  2. 2.
    Onda T, Yoshikawa H, Yasugi T et al (2005) Secondary cytoreductive surgery for recurrent epithelial ovarian carcinoma: proposal for patients selection. Br J Cancer 92:1026–1032CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Parmar MK, Ledermann JA, Colombo N et al (2003) Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet 361:2099–2106CrossRefPubMedGoogle Scholar
  4. 4.
    Wagner U, Marth C, Largillier R et al (2012) Final overall survival results of phase III GCIG CALYPSO trial of pegylated liposomal doxorubicin and carboplatin vs paclitaxel and carboplatin in platinum-sensitive ovarian cancer patients. Br J Cancer 107:588–591CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Aghajanian C, Blank SV, Goff BA et al (2012) OCEANS: a randomized, double-blind, placebo-controlled phase III trial of chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent epithelial ovarian, primary peritoneal, or fallopian tube cancer. J Clin Oncol 30:2039–2045CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Harter P, Heitz F, du Bois A et al (2012) Surgery for relapsed ovarian cancer: when should it be offered? Curr Oncol Rep. 14:539–543CrossRefPubMedGoogle Scholar
  7. 7.
    Harter P, du Bois A, Hahmann M et al (2006) Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol 13:1702–1710CrossRefPubMedGoogle Scholar
  8. 8.
    Sehouli J, Richter R, Braicu EI et al (2010) Role of secondary cytoreductive surgery in ovarian cancer relapse: who will benefit? a systematic analysis of 240 consecutive patients. J Surg Oncol 102:656–662CrossRefPubMedGoogle Scholar
  9. 9.
    Oksefjell H, Sandstad B, Trope C (2009) The role of secondary cytoreduction in the management of the first relapse in epithelial ovarian cancer. Ann Oncol 20:286–293CrossRefPubMedGoogle Scholar
  10. 10.
    Tian WJ, Jiang R, Cheng X et al (2010) Surgery in recurrent epithelial ovarian cancer: benefits on survival for patients with residual disease of 0.1–1 cm after secondary cytoreduction. J Surg Oncol 101:244–250PubMedGoogle Scholar
  11. 11.
    Zang RY, Li ZT, Tang J et al (2004) Secondary cytoreductive surgery for patients with relapsed epithelial ovarian carcinoma: who benefits? Cancer 100:1152–1161CrossRefPubMedGoogle Scholar
  12. 12.
    Zang RY, Harter P, Chi DS et al (2011) Predictors of survival in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery based on the pooled analysis of an international collaborative cohort. Br J Cancer 105:890–896CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Eisenkop SM, Friedman RL, Spirtos NM (2000) The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma. Cancer 88:144–153CrossRefPubMedGoogle Scholar
  14. 14.
    Chi DS, McCaughty K, Diaz JP et al (2006) Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent, platinum-sensitive epithelial ovarian carcinoma. Cancer 106:1933–1939CrossRefPubMedGoogle Scholar
  15. 15.
    Harter P, Sehouli J, Reuss A et al (2011) Prospective validation study of a predictive score for operability of recurrent ovarian cancer: the multicenter intergroup study DESKTOP II. A project of the AGO kommission OVAR, AGO Study Group, NOGGO, AGO-Austria, and MITO. Int J Gynecol Cancer 21:289–295CrossRefPubMedGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2015

Authors and Affiliations

  • Takeo Minaguchi
    • 1
    Email author
  • Toyomi Satoh
    • 1
  • Koji Matsumoto
    • 1
  • Manabu Sakurai
    • 1
  • Hiroyuki Ochi
    • 1
  • Mamiko Onuki
    • 1
  • Akinori Oki
    • 1
  • Hiroyuki Yoshikawa
    • 1
  1. 1.Department of Obstetrics and Gynecology, Faculty of MedicineUniversity of TsukubaTsukubaJapan

Personalised recommendations