Tertiary cytoreduction for recurrent ovarian carcinoma: An updated and expanded analysis Journal Article

   


Authors: Manning-Geist, B. L.; Chi, D. S.; Long Roche, K.; Zivanovic, O.; Sonoda, Y.; Gardner, G. J.; O'Cearbhaill, R. E.; Abu-Rustum, N. R.; Leitao, M. M. Jr
Article Title: Tertiary cytoreduction for recurrent ovarian carcinoma: An updated and expanded analysis
Abstract: Objective: We sought to describe clinicopathologic and surgical factors associated with oncologic outcomes in patients undergoing tertiary cytoreduction and to present a clinical model to identify patients with high-grade serous ovarian cancer (HGSOC) who may benefit most from tertiary cytoreduction. Methods: We retrospectively identified patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who underwent tertiary cytoreduction at our institution from 1/1/1990–1/1/2019. Kaplan-Meier curves were used to estimate survival and compared using the log-rank test. Cox-proportional hazards regression was used to detect variables associated with survival. Results: Of 114 patients who met inclusion criteria, 79 (69.2%) had high-grade serous tumors. Of patients with available genetic testing (n = 66), 22 (33%) harbored germline or somatic BRCA mutations. Fifty-eight women (50.9%) died of disease. Complete gross resection (CGR) at tertiary cytoreduction, treatment-free interval (TFI), and platinum sensitivity were all significantly associated with disease-specific survival (DSS) and maintained significance on multivariate analysis (HR 3.71, 95% CI: 1.59–8.70; HR 0.49, 95% CI: 0.28–0.85; and HR 2.94, 95% CI: 1.22–7.07, respectively). Postoperative treatment was not associated with a survival difference. Patients with HGSOC and a single site of recurrence who were ≥2 years from secondary cytoreduction had the longest survival after tertiary cytoreduction (median DSS, 79.5 months). Conclusions: Proper patient selection for tertiary cytoreduction is essential. Those who achieve CGR likely derive the greatest benefit from tertiary surgery. Platinum sensitivity and prolonged TFI are also associated with improved DSS. Patients with HGSOC and single-site recurrence who were ≥2 years out from secondary cytoreduction had the longest DSS. © 2021 Elsevier Inc.
Keywords: ovarian cancer; surgery; tertiary cytoreduction; high-grade serous ovarian carcinoma
Journal Title: Gynecologic Oncology
Volume: 162
Issue: 2
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2021-08-01
Start Page: 345
End Page: 352
Language: English
DOI: 10.1016/j.ygyno.2021.05.015
PUBMED: 34045053
PROVIDER: scopus
PMCID: PMC8319116
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85106516514&doi=10.1016%2fj.ygyno.2021.05.015&partnerID=40&md5=7cfc3a3bbaeb91e5dd01ba3d9f0a9429
Notes: Article -- Export Date: 1 September 2021 -- Source: Scopus
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MSK Authors
  1. Ginger J Gardner
    270 Gardner
  2. Dennis S Chi
    707 Chi
  3. Yukio Sonoda
    473 Sonoda
  4. Mario Leitao
    575 Leitao
  5. Nadeem Abu-Rustum
    888 Abu-Rustum
  6. Oliver Zivanovic
    291 Zivanovic
  7. Roisin Eilish O'Cearbhaill
    272 O'Cearbhaill
  8. Kara Long Roche
    247 Long Roche
  9. Beryl Manning-Geist
    51 Manning-Geist
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