The role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer. A project of the AGO-OVAR and GINECO – Prognostic factor surgical outcome in advanced ovarian cancer

Purpose: Primary surgery followed by platinum-taxane based chemotherapy is the standard therapy in advanced ovarian cancer. However, the prognostic role of complete and so-called optimal and suboptimal debulking and its interaction with biological factors is still not fully defined.

Patients and methods: Exploratory analysis of three prospective randomized trials (AGO-OVAR 3, 5 & 7) investigating platinum-taxane based chemotherapy regimens in advanced ovarian cancer and conducted between 1995 and 2002.

Results: 3,126 pts were analysed. Approximately one third each fulfilled criteria for complete resection (group A), small residual tumor burden of 1–10mm (B), or gross residual disease exceeding 1 cm diameter (C). Multivariate analysis showed showed improved progression-free (PFS) and overall survival (OS) for group A with complete resection compared to groups B or C (p<0.0001). The impact of so-called optimal debulking as in group B showed a smaller prognostic impact compared to group C. Further independent prognostic factors for OS were age, performance status, grade, FIGO stage, and histology, namely the mucinous subtype. The interaction between residual tumor and some biologic factors could be demonstrated (eg. grade remained only significant in completely debulked patients).

Conclusion: The goal of primary surgery should be complete resection. The prognostic impact of tumor biology seemed to be overruled by residual tumor and further evaluation of biologic factors (and eventually biologic therapies) should focuss on completely debulked patients.

ovarian cancer - prognostic factors - surgery - surgical outcome