| Objectives:Advanced ovarian cancer is the worst prognosis in gynecological malignancies.More than 80 percent of patients who have undergone initial treatment(primary cytoreductive surgery and platinum-based chemotherapy)will have a recurrence.The insensitivity to traditional treatment is a difficult problem.Currently.the treatment of recurrent ovarian cancer mainly includes secondary cytoreductive surgery(SCS),chemotherapy and molecular targeted therapy.But so far,it is uniform.The application of SCS in recurrent ovarian cancer and effects on the prognosis remains one of the hot topics of international discussion.The selection about patients,timing and indications of the operation are still unclear.The aim of this study was to evaluate effectiveness of secondary cytoreductive surgery in platinum-sensitive relapsed serous ovarian cancer(RESOC)patients and to assess prognostic factors on overall post-recurrence survival time.Methods:From the electronic databases of the Department of gynecological oncology at Women’s Hospital School of Medicine Zhejiang University between 2000 and 2015,a cohort of 190 RESOC patients were selected and divided into two groups according to the therapy method after relapse:secondary cytoreduction&chemotherapy(n=28)and chemotherapy alone(n=162).Survival analysis and comparisons were performed using the Kaplan-Meier method,Log-rank test,Wilcoxon test and Cox multivariate proportional hazards model.Results:①Mean(±standard deviation[SD])patients’ age in the secondary cytoreduction&chemotherapy group was 45.36(±10.36)years,mean(±SD)patients’ age in the chemotherapy alone group was 52.27(±9.04)years(P=0.339).②The overall survival(OS)in the secondary cytoreduction&chemotherapy group was significantly longer than the chemotherapy alone group,the median OS was 75 months(95%CI 56.261-93.739)versus 45 months(95%CI 40.518-49.482)(p<0.001).The three-year and five-year survival rates of the secondary cytoreduction&chemotherapy group and the chemotherapy alone group were 92%and 78%,49%and 30%respectively(p<0.001).③ Univariate analysis showed that the median OS was significantly correlated with primary optimal cytoreduction(p=0.003),early stage(p=0.021),CA125<1000U/ml(p=0.009),recurrent interval>12months(p<0.001)and secondary cytoreduction(p<0.001).④ Multivariate Cox regression analysis revealed that primary optimal cytoreduction,recurrent interval and therapy method after relapse were independent associated factors(P=0.008,P<0.001,p=0.002 respectively).⑤There are 46 advanced serous ovarian cancer patients with primary optimal cytoreduction and recurrent interval>12months,including secondary cytoreduction&chemotherapy(n=13)and chemotherapy alone(n=33),the median OS was 74 months(95%CI 24.621-123.379)versus 58 months(95%CI 41.119-74.881)(p=0.029).⑥The secondary cytoreduction&chemotherapy group was divided into two groups according to whether the secondary cytoreduction was total macroscopic tumor resection:optimal group(total macroscopic tumor resection,n=26),nonoptimal group(partial macroscopic tumor resection,n=2).The overall survival(OS)in the optimal group was significantly longer than the other group,the median OS was 82 months versus 32 months(p<0.001).⑦Total macroscopic tumor resection was obtained during secondary cytoreductive surgery in 26 patients,24(92.3%)in the AGO-positive group and 2(7.7%)in the AGO-negative group.Conclusions:The median OS was significantly correlated with primary optimal cytoreduction,stage,the level of CA125,recurrent interval and therapy method after relapse.Primary optimal cytoreduction,recurrent interval and therapy method after relapse were independent associated factors.After careful selection,optimal cytoreduction can be achieved in most patients who are subjected to secondary surgical cytoreduction with a better OS.Primary optimal cytoreduction and recurrent interval represent the most important prognostic factors.AGO score has important predictive value for the outcome of SCS. |
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