Secondary Surgery Associated With Improved Survival in Ovarian Cancer

A secondary cytoreductive surgery along with chemotherapy following recurrence in patients with epithelial ovarian cancer offered improved outcomes over treatment with chemotherapy alone, according to a new study.

“Epithelial ovarian cancer recurs in up to 75% of patients, even those with complete cytoreduction after primary surgery,” wrote study authors led by Witold Szczesny, MD, of Cancer Registry Norway in Oslo. Some evidence has suggested that a secondary surgery at the point of recurrence might improve outcomes.

The new trial was a retrospective study of 397 patients with epithelial ovarian cancer who underwent primary surgery with no residuals, and who then received platinum-based chemotherapy. All patients had a recurrence 6 or more months after completion of chemotherapy, at which point 75 patients were treated with secondary cytoreductive surgery (60 achieved complete resection) plus chemotherapy, and 322 were treated with chemotherapy alone. The results of the study were published in Acta Obstetricia et Gynecologica Scandinavica.

The patients who underwent surgery were younger at initial diagnosis, at 58 years compared with 59 years (P = .02). Stage, histology, and tumor grade were similar between the two groups.

The median progression-free survival (PFS) in the surgery group was 2 years, compared with 1 year in the chemotherapy-alone group. After adjustments for confounding variables including age, stage, histology, and others, the hazard ratio (HR) for PFS favored the surgery group, at 0.45 (95% CI, 0.32–0.62; P < .001).

The median overall survival (OS) was 6 years with surgery, and 2 years without it. The multivariate HR for OS was 0.50 (95% CI, 0.32–0.70; P < .001).

When the analysis was restricted to the 60 patients in the surgery group (80%) who had a complete resection, the benefit was larger. The HR for PFS was 0.34 (95% CI, 0.23–0.51), and for OS it was 0.36 (95% CI, 0.22–0.57).

“Improved survival in our [surgery] group does not necessarily mean that survival would have been better for patients in the platinum-based chemotherapy group if they had first been treated with secondary cytoreductive surgery,” the authors noted. “The role of secondary cytoreductive surgery in recurrent ovarian cancer treatment has not been clearly defined, and conclusive evidence is lacking.” They added that a long treatment-free interval and the presence of three or fewer lesions could be considered useful predictors of complete resection at the time of surgery.