ABSTRACT
Epithelial Ovarian cancer is the most lethal and silent gynaecological tumor and relapses in about 75% of cases. Retrospective data supported the superiority of secondary cytoreduction surgery (SCS) plus chemotherapy versus chemotherapy alone; in order to best select patients for SCS literature established a clinical score based on ascites, performance status, and absence of residual disease to primary surgery.
The present study analyzed the outcomes and pattern of relapse of a population with first relapse of ovarian cancer undergoing secondary surgery without residual tumor divided into two groups based on the type of treatment at the first diagnosis (primary debulking surgery [PDS] or neoadjuvant chemotherapy followed by interval debulking surgery [IDS]).
This is an observational retrospective study carried out at the referred Centre of Oncologic Gynaecology of Bologna, Italy on patients who underwent SCS for ovarian cancer between January 2009 and December 2019 retrieved in an electronic data-base. Clinical surgical and pathological data were analyzed. Data about time and pattern of relapse and overall survival were evaluated.
Out of 270 ovarian cancer patients, 69 were enrolled in the study; 49 patients who at first received primary surgery (Group 1) and 20 patients at first received interval surgery (Group 2). The 5-year Post Relapse Overall Survival in Group 1 was 76% and in Group 2 30% (p = 0.0042). The 5-year Post Relapse Disease Free Survival in Group 1 was 49% and in Group 2 30% (p = 0.08). Regarding the pattern of relapse, Group 2 relapsed more frequently as multifocal peritoneal disease (75%) respect to Group 1 (41%) (p = 0.02). Finally, relapse after primary debulking surgery resulted in a more favourable pattern of recurrent disease, and secondary surgery after PDS offered longer survival.
Our study lays the foundation for considering the primary treatment received by patients among the selection variables for secondary cytoreduction surgery.