Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial.

Abstract

BACKGROUND:

The role of cytoreductive surgery in relapsed ovarian cancer is not clearly defined. Therefore, patient selection remains arbitrary and depends on the center's preference rather than on established selection criteria. The Descriptive Evaluation of preoperative Selection KriTeria for OPerability in recurrent OVARian cancer (DESKTOP OVAR) trial was undertaken to form a hypothesis for a panel of criteria for selecting patients who might benefit from surgery in relapsed ovarian cancer.

METHODS:

The DESKTOP trial was an exploratory study based on data from a retrospective analysis of hospital records. Twenty-five member institutions of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee (AGO OC) and AGO-OVAR boards collected data on their patients with cytoreductive surgery for relapsed invasive epithelial ovarian cancer performed in 2000-2003.

RESULTS:

Two hundred and sixty-seven patients were included. Complete resection was associated with significantly longer survival compared with surgery leaving any postoperative residuals [median 45.2 vs. 19.7 months; hazard ratio (HR) 3.71; 95% confidence interval (CI) 2.27-6.05; P < .0001]. Variables associated with complete resection were performance status (PS) [Eastern Cooperative Oncology Group (ECOG) 0 vs. > 0; P < .001], International Federation of Gynecology and Obstetrics (FIGO) stage at initial diagnosis (FIGO I/II vs. III/IV, P = .036), residual tumor after primary surgery (none vs. present, P <.001), and absence of ascites > 500 ml (P < .001). A combination of PS, early FIGO stage initially or no residual tumor after first surgery, and absence of ascites could predict complete resection in 79% of patients.

CONCLUSIONS:

Only complete resection was associated with prolonged survival in recurrent ovarian cancer. The identified criteria panel will be verified in a prospective trial (AGO-DESKTOP II) evaluating whether it will render a useful tool for selecting the right patients for cytoreductive surgery in recurrent ovarian cancer.

• Authors: Philipp Harter, Andreas du Bois, Maik Hahmann, Annette Hasenburg, Alexander Burges, Sibylle Loibl, Martina Gropp, Jens Huober, Daniel Fink, Willibald Schröder, Karsten Muenstedt, Barbara Schmalfeldt, Guenter Emons, Jacobus Pfisterer, Kerstin Wollschlaeger, Hans-Gerd Meerpohl, Georg-Peter Breitbach, Berno Tanner, Jalid Sehouli, Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee, AGO Ovarian Cancer Study Group
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 13 Issue 12 Pg. 1702-10 (Dec 2006) ISSN: 1068-9265 [Print] United States
• PMID: 17009163 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)

Topics

• Adult
• Aged
• Aged, 80 and over
• Female
• Gynecologic Surgical Procedures (mortality)
• Humans
• Middle Aged
• Neoplasm Recurrence, Local (surgery)
• Neoplasm, Residual (diagnosis, surgery)
• Neoplasms, Glandular and Epithelial (mortality, surgery)
• Ovarian Neoplasms (mortality, surgery)
• Prognosis
• Survival Rate