Tertiary cytoreductive surgery in recurrent epithelial ovarian cancer: A multicentre MITO retrospective study

F Falcone, G Scambia, P Benedetti Panici, M Signorelli, G Cormio, G Giorda, S Bogliolo, M Marinaccio, F Ghezzi, E Rabaiotti, E Breda, G Casella, F Fanfani, V Di Donato, U Leone Roberti Maggiore, S Greggi

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Abstract

OBJECTIVES: To evaluate the impact of tertiary cytoreductive surgery (TCS) on survival in recurrent epithelial ovarian cancer (EOC), and to determine predictors of complete cytoreduction.

METHODS: A multi-institutional retrospective study was conducted within the MITO Group on a 5-year observation period.

RESULTS: A total of 103 EOC patients with a ≥6month treatment-free interval (TFI) undergoing TCS were included. Complete cytoreduction was achieved in 71 patients (68.9%), with severe post-operative complications in 9.7%, and no cases of mortality within 60days from surgery. Multivariate analysis identified the complete tertiary cytoreduction as the most potent predictor of survival followed by FIGO stage I-II at initial diagnosis, exclusive retroperitoneal recurrence, and TCS performed ≥3years after primary diagnosis. Patients with complete tertiary cytoreduction had a significantly longer overall survival (median OS: 43months, 95% CI 31-58) compared to those with residual tumor (median OS: 33months, 95% CI 28-46; p<0.001). After multivariate adjustment the presence of a single lesion and good (ECOG 0) performance status were the only significant predictors of complete surgical cytoreduction.

CONCLUSIONS: This is the only large multicentre study published so far on TCS in EOC with ≥6month TFI. The achievement of postoperative no residual disease is confirmed as the primary objective also in a TCS setting, with significant survival benefit and acceptable morbidity. Accurate patient selection is of utmost importance to have the best chance of complete cytoreduction.

Original languageEnglish
Pages (from-to)66-72
Number of pages7
JournalGynecologic Oncology
Volume147
Issue number1
DOIs
Publication statusPublished - Oct 2017

Fingerprint

Retrospective Studies
Survival
Social Adjustment
Residual Neoplasm
Patient Selection
Multicenter Studies
Ovarian epithelial cancer
Multivariate Analysis
Observation
Morbidity
Recurrence
Mortality
Therapeutics

Keywords

  • Adult
  • Aged
  • Cytoreduction Surgical Procedures
  • Female
  • Humans
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Recurrence, Local
  • Neoplasms, Glandular and Epithelial
  • Ovarian Neoplasms
  • Retrospective Studies
  • Risk Factors
  • Young Adult
  • Journal Article
  • Multicenter Study

Cite this

Tertiary cytoreductive surgery in recurrent epithelial ovarian cancer : A multicentre MITO retrospective study. / Falcone, F; Scambia, G; Benedetti Panici, P; Signorelli, M; Cormio, G; Giorda, G; Bogliolo, S; Marinaccio, M; Ghezzi, F; Rabaiotti, E; Breda, E; Casella, G; Fanfani, F; Di Donato, V; Leone Roberti Maggiore, U; Greggi, S.

In: Gynecologic Oncology, Vol. 147, No. 1, 10.2017, p. 66-72.

Research output: Contribution to journalArticle

Falcone, F, Scambia, G, Benedetti Panici, P, Signorelli, M, Cormio, G, Giorda, G, Bogliolo, S, Marinaccio, M, Ghezzi, F, Rabaiotti, E, Breda, E, Casella, G, Fanfani, F, Di Donato, V, Leone Roberti Maggiore, U & Greggi, S 2017, 'Tertiary cytoreductive surgery in recurrent epithelial ovarian cancer: A multicentre MITO retrospective study', Gynecologic Oncology, vol. 147, no. 1, pp. 66-72. https://doi.org/10.1016/j.ygyno.2017.07.008
Falcone, F ; Scambia, G ; Benedetti Panici, P ; Signorelli, M ; Cormio, G ; Giorda, G ; Bogliolo, S ; Marinaccio, M ; Ghezzi, F ; Rabaiotti, E ; Breda, E ; Casella, G ; Fanfani, F ; Di Donato, V ; Leone Roberti Maggiore, U ; Greggi, S. / Tertiary cytoreductive surgery in recurrent epithelial ovarian cancer : A multicentre MITO retrospective study. In: Gynecologic Oncology. 2017 ; Vol. 147, No. 1. pp. 66-72.
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title = "Tertiary cytoreductive surgery in recurrent epithelial ovarian cancer: A multicentre MITO retrospective study",
abstract = "OBJECTIVES: To evaluate the impact of tertiary cytoreductive surgery (TCS) on survival in recurrent epithelial ovarian cancer (EOC), and to determine predictors of complete cytoreduction.METHODS: A multi-institutional retrospective study was conducted within the MITO Group on a 5-year observation period.RESULTS: A total of 103 EOC patients with a ≥6month treatment-free interval (TFI) undergoing TCS were included. Complete cytoreduction was achieved in 71 patients (68.9{\%}), with severe post-operative complications in 9.7{\%}, and no cases of mortality within 60days from surgery. Multivariate analysis identified the complete tertiary cytoreduction as the most potent predictor of survival followed by FIGO stage I-II at initial diagnosis, exclusive retroperitoneal recurrence, and TCS performed ≥3years after primary diagnosis. Patients with complete tertiary cytoreduction had a significantly longer overall survival (median OS: 43months, 95{\%} CI 31-58) compared to those with residual tumor (median OS: 33months, 95{\%} CI 28-46; p<0.001). After multivariate adjustment the presence of a single lesion and good (ECOG 0) performance status were the only significant predictors of complete surgical cytoreduction.CONCLUSIONS: This is the only large multicentre study published so far on TCS in EOC with ≥6month TFI. The achievement of postoperative no residual disease is confirmed as the primary objective also in a TCS setting, with significant survival benefit and acceptable morbidity. Accurate patient selection is of utmost importance to have the best chance of complete cytoreduction.",
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author = "F Falcone and G Scambia and {Benedetti Panici}, P and M Signorelli and G Cormio and G Giorda and S Bogliolo and M Marinaccio and F Ghezzi and E Rabaiotti and E Breda and G Casella and F Fanfani and {Di Donato}, V and {Leone Roberti Maggiore}, U and S Greggi",
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year = "2017",
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doi = "10.1016/j.ygyno.2017.07.008",
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T1 - Tertiary cytoreductive surgery in recurrent epithelial ovarian cancer

T2 - A multicentre MITO retrospective study

AU - Falcone, F

AU - Scambia, G

AU - Benedetti Panici, P

AU - Signorelli, M

AU - Cormio, G

AU - Giorda, G

AU - Bogliolo, S

AU - Marinaccio, M

AU - Ghezzi, F

AU - Rabaiotti, E

AU - Breda, E

AU - Casella, G

AU - Fanfani, F

AU - Di Donato, V

AU - Leone Roberti Maggiore, U

AU - Greggi, S

N1 - Copyright © 2017 Elsevier Inc. All rights reserved.

PY - 2017/10

Y1 - 2017/10

N2 - OBJECTIVES: To evaluate the impact of tertiary cytoreductive surgery (TCS) on survival in recurrent epithelial ovarian cancer (EOC), and to determine predictors of complete cytoreduction.METHODS: A multi-institutional retrospective study was conducted within the MITO Group on a 5-year observation period.RESULTS: A total of 103 EOC patients with a ≥6month treatment-free interval (TFI) undergoing TCS were included. Complete cytoreduction was achieved in 71 patients (68.9%), with severe post-operative complications in 9.7%, and no cases of mortality within 60days from surgery. Multivariate analysis identified the complete tertiary cytoreduction as the most potent predictor of survival followed by FIGO stage I-II at initial diagnosis, exclusive retroperitoneal recurrence, and TCS performed ≥3years after primary diagnosis. Patients with complete tertiary cytoreduction had a significantly longer overall survival (median OS: 43months, 95% CI 31-58) compared to those with residual tumor (median OS: 33months, 95% CI 28-46; p<0.001). After multivariate adjustment the presence of a single lesion and good (ECOG 0) performance status were the only significant predictors of complete surgical cytoreduction.CONCLUSIONS: This is the only large multicentre study published so far on TCS in EOC with ≥6month TFI. The achievement of postoperative no residual disease is confirmed as the primary objective also in a TCS setting, with significant survival benefit and acceptable morbidity. Accurate patient selection is of utmost importance to have the best chance of complete cytoreduction.

AB - OBJECTIVES: To evaluate the impact of tertiary cytoreductive surgery (TCS) on survival in recurrent epithelial ovarian cancer (EOC), and to determine predictors of complete cytoreduction.METHODS: A multi-institutional retrospective study was conducted within the MITO Group on a 5-year observation period.RESULTS: A total of 103 EOC patients with a ≥6month treatment-free interval (TFI) undergoing TCS were included. Complete cytoreduction was achieved in 71 patients (68.9%), with severe post-operative complications in 9.7%, and no cases of mortality within 60days from surgery. Multivariate analysis identified the complete tertiary cytoreduction as the most potent predictor of survival followed by FIGO stage I-II at initial diagnosis, exclusive retroperitoneal recurrence, and TCS performed ≥3years after primary diagnosis. Patients with complete tertiary cytoreduction had a significantly longer overall survival (median OS: 43months, 95% CI 31-58) compared to those with residual tumor (median OS: 33months, 95% CI 28-46; p<0.001). After multivariate adjustment the presence of a single lesion and good (ECOG 0) performance status were the only significant predictors of complete surgical cytoreduction.CONCLUSIONS: This is the only large multicentre study published so far on TCS in EOC with ≥6month TFI. The achievement of postoperative no residual disease is confirmed as the primary objective also in a TCS setting, with significant survival benefit and acceptable morbidity. Accurate patient selection is of utmost importance to have the best chance of complete cytoreduction.

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KW - Humans

KW - Middle Aged

KW - Multivariate Analysis

KW - Neoplasm Recurrence, Local

KW - Neoplasms, Glandular and Epithelial

KW - Ovarian Neoplasms

KW - Retrospective Studies

KW - Risk Factors

KW - Young Adult

KW - Journal Article

KW - Multicenter Study

U2 - 10.1016/j.ygyno.2017.07.008

DO - 10.1016/j.ygyno.2017.07.008

M3 - Article

C2 - 28716306

VL - 147

SP - 66

EP - 72

JO - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

IS - 1

ER -