A Risk Model for Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer: An Evidence-Based Proposal for Patient Selection

• Published in: Annals of surgical oncology Vol. 19; no. 2; pp. 597 - 604
• Main Authors: Tian, Wen-Juan, Chi, Dennis S., Sehouli, Jalid, Tropé, Claes G., Jiang, Rong, Ayhan, Ali, Cormio, Gennaro, Xing, Yan, Breitbach, Georg-Peter, Braicu, Elena Ioana, Rabbitt, Catherine A., Oksefjell, Halldis, Fotopoulou, Christina, Meerpohl, Hans-Gerd, du Bois, Andreas, Berek, Jonathan S., Zang, Rong-Yu, Harter, Philipp
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.02.2012; Springer Nature B.V
• Subjects: Adenocarcinoma, Clear Cell - mortality; Adenocarcinoma, Clear Cell - pathology; Adenocarcinoma, Clear Cell - surgery; Adenocarcinoma, Mucinous - mortality; Adenocarcinoma, Mucinous - pathology; Adenocarcinoma, Mucinous - surgery; Adolescent; Adult; Aged; Aged, 80 and over; Cystadenocarcinoma, Serous - mortality; Cystadenocarcinoma, Serous - pathology; Cystadenocarcinoma, Serous - surgery; Female; Gynecologic Oncology; Humans; International Agencies; Medicine; Medicine & Public Health; Middle Aged; Models, Statistical; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Oncology; Ovarian cancer; Ovarian Neoplasms - mortality; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Ovariectomy; Patient Selection; Risk Factors; Surgery; Surgical Oncology; Survival Rate; Treatment Outcome; Young Adult; Recurrent Ovarian Cancer; Complete Cytoreduction; Eastern Cooperative Oncology Group Performance Status; Risk Model; Figo Stage
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-011-1873-2

Background To develop a risk model for predicting complete secondary cytoreductive surgery (SCR) in patients with recurrent ovarian cancer. Methods Individual data of 1075 patients with recurrent ovarian cancer undergoing SCR from 7 worldwide centers were pooled and analyzed. The risk model was developed based on the factors impacting on SCR surgical outcome. Additional data on 117 patients who were not included in the development of the model were used for external validation and to assess the discrimination of the model. Results Of the 1075 patients, 434 (40.4%) underwent complete resection. Complete secondary cytoreduction was associated with six variables: FIGO stage (odds ratio [OR] = 1.32, 95% confidence interval [95% CI]: 0.97–1.80), residual disease after primary cytoreduction (OR = 1.69, 95% CI: 1.26–2.27), progression-free interval (OR = 2.27, 95% CI: 1.71–3.01), Eastern Cooperative Oncology Group (ECOG) performance status (OR = 2.23, 95% CI: 1.45–3.44), CA125 (OR = 1.85, 95% CI: 1.41–2.44), and ascites at recurrence (OR = 2.79, 95% CI: 1.88–4.13). These variables were entered into the risk model and assigned scores ranging from 0 to 11.9. Patients with total scores of 0–4.7 were categorized as the low-risk group, in which the proportion of complete cytoreduction was 53.4% compared with 20.1% in the high-risk group (OR = 4.55, 95% CI: 3.43–6.04). In external validation, the sensitivity and specificity was 83.3% and 57.6%, respectively. Area under the curve of the receiver-operating characteristics for predicting complete SCR was 0.68 (95% CI: 0.60–0.79). Conclusions This model and scoring system may well predict the outcome of SCR and could potentially be useful in future clinical trials to determine which patients with recurrent ovarian cancer should have SCR as part of their management.