Advanced Epithelial Ovarian Cancer:Redefinition Of The Cutoff-point Of Optimal Cytoreduction

Background&Objective:The size of residual disease after primary cytoreductive surgery has been known to be obviously assocciated with long-term prognosis of patients with advanced epithelial ovarian cancer. But over the past few decades, the cutoff-point of "optimal" cytoreduction is still controversial. The main objective of this study is to evaluate the prognostic influence of multiple factors in patients with advanced EOC and to discuss the redefinition of "optimal" cytoreduction.Methods:In this retrospective, single-institution study,199patients with advanced EOC (International Federation of Gynecology and Obstetrics stage Ⅱ-Ⅳ) were selected according to the following selection criteria:①treated between Feb,2005and Jul,2010for the first time in Qilu Hospital of shandong university;②no neoadjuvant chemotherapy before surgical management;③postoperative pathology proved epithelial ovarian cancer;④FIGO stage Ⅱ-Ⅳ;④treated with postoperative platinum-based adjuvant combination chemotherapy for at least1cycle. According to the size of residual disease, patients were divided into four groups:no visible residual disease, visible residual disease with diameter<1cm, residual disease with diameter between1to2cm and residual disease with diameter>2cm. With the follow-up results and the help of SPSS16.0, prognotic analysis was made and survival rates were calculated and compared among different groups.Results:Of the199cases aged between22to87years old(both average and median,58years), the overall3-year survival rate was55.2%and the overall median survival time was39months. Serous adenocarcinoma(146cases,73.4%) was the most common pathological type, compared with mucinous adenocarcinoma (21cases, 10.6%) and other types (32cases,16.0%). Multivariable survival analysis indicates that age of diagnosis,the stage of the patients and the size of residual disease after primary cytoreductive surgery (P<0.05) are three independent factors which have significant impact on the long-term prognosis of advanced EOC, while the preoperative level of serum CA125,tumor grade and pathological types are not (P>0.05). According to the Kaplan-Meier survival analysis, in the size of residual disease, group A (56cases) and group B (49cases) had a similar3-year survival rate with each other (66.1%vs.63.6%,P=0.470), and group C (29cases) and group D (65cases) had a similar3-year survival rate with each other (47.8%vs.41.0%,P=0.992). Both group A and group B had a superior3-year survival rate than either group C or group D(P<0.05), and group A combined with group B also had a superior3-year survival rate than group C combined with group D(65.3%vs.43.3%,P<0.05). In age of onset, the group of patients under60years had a superior3-year survival rate than the group of those over60years.Conclusion:Age, grade and the size of residual disease after primary cytoreductive surgery have significant prognostic impact on long-term survival of patients with epithelial ovarian cancer of FIGO stage Ⅱ-Ⅳ. Older patients have poorer survival rate than youger ones. The concept of "optimal" cytoreduction can be defined as residual disease with cutoff-diameter less than1cm. Patients who received optimal cytoreduction have a obviously superior outcome contrasted with patients who didn’t. Maximal cytoreductive effort should be used to achieve the goal of "optimal" cytoreduction.