A score system for complete cytoreduction in selected recurrent ovarian cancer patients undergoing secondary cytoreductive surgery: predictors- and nomogram-based analyses

Abstract

ObjectiveTo test the applicability of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Memorial Sloan Kettering (MSK) criteria in predicting complete cytoreduction (CC) in patients undergoing secondary cytoreductive surgery (SCS) for recurrent ovarian cancer (ROC).MethodsData of consecutive patients undergoing SCS were reviewed. The Arbeitsgemeinschaft Gynäkologische Onkologie OVARian cancer study group (AGO-OVAR) and MSK criteria were retrospectively applied. Nomograms, based on AGO criteria, MSK criteria and both AGO and MSK criteria were built in order to assess the probability to achieve CC at SCS.ResultsOverall, 194 patients met the inclusion criteria. CC was achieved in 161 (82.9%) patients. According to the AGO-OVAR criteria, we observed that CC was achieved in 87.0% of patients with positive AGO score. However, 45 out of 71 (63.4%) patients who did not fulfilled the AGO score had CC. Similarly, CC was achieved in 87.1%, 61.9% and 66.7% of patients for whom SCS was recommended, had to be considered and was not recommended, respectively. In order to evaluate the predictive value of the AGO-OVAR and MSK criteria we built 2 separate nomograms (c-index: 0.5900 and 0.5989, respectively) to test the probability to achieve CC at SCS. Additionally, we built a nomogram using both the aforementioned criteria (c-index: 0.5857).ConclusionThe AGO and MSK criteria help identifying patients deserving SCS. However, these criteria might be strict, thus prohibiting a beneficial treatment in patients who do not met these criteria. Further studies are needed to clarify factors predicting CC at SCS.

The addition of lymphadenectomy to secondary cytoreductive surgery in comparison with bulky node resection in patients with recurrent ovarian cancer

“…Exclusion criteria were withdrawal of consent; presence of gross peritoneal disease at the time of SCS; positive results of cytological evaluation of peritoneal cavity; performance status not allowing surgical treatment; and early stage of disease at primary surgery (FIGO stage I or II). Demographic data (i.e., age), preoperative CA125 levels (UI/L), and performance status (assessed by the Eastern Cooperative Oncology Group scale) data were collected.…”

“…Central pathology review was performed in all cases for patients having primary treatment in other centers. Details about the treatment protocols used for SCS are reported elsewhere . According to institutional protocols, SCS was offered to patients experiencing recurrent disease with a DFI longer than 6 months .…”

“…Details about the treatment protocols used for SCS are reported elsewhere . According to institutional protocols, SCS was offered to patients experiencing recurrent disease with a DFI longer than 6 months . No specific guidelines were available for the selection of patients for SCS; however, surgery was offered after evaluation of the parameters included in both the AGO‐OVAR and MSK criteria, namely no residual disease at first surgery; good performance status; absence of ascites; site of recurrence, and DFI .…”

“…No specific guidelines were available for the selection of patients for SCS; however, surgery was offered after evaluation of the parameters included in both the AGO‐OVAR and MSK criteria, namely no residual disease at first surgery; good performance status; absence of ascites; site of recurrence, and DFI . In line with institutional protocols, patients with suspected isolated nodal recurrence were selected for SCS . According to RECIST (response evaluation criteria in solid tumours) version 1.1, nodes were defined as bulky when their short axis was greater than 10 mm .…”

“…Para‐aortic lymphadenectomy required the removal of lymphatic tissue from the aorta and vena cava; the renal vessels represented the upper limit of dissection. A detailed description of pelvic and para‐aortic node dissection has been reported previously . Groin lymphadenectomy was performed removing both superficial and deep inguinal nodes.…”