Artikel
The role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer. A combined exploratory analysis of three prospectively randomized phase III multicenter trials
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Autoren
Veröffentlicht: | 10. September 2008 |
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Gliederung
Text
Background
Primary surgery followed by platinum-taxane based chemotherapy is the standard therapy in advanced ovarian cancer. But the prognostic role of complete and so-called optimal and suboptimal debulking and biological factors are still not clearly defined.
Methods
We performed an exploratory pooled analysis of three prospective randomized trials (AGO-OVAR 3, 5 & 7 [Ref. 1], [Ref. 2], [Ref. 3]) that investigated platinum-taxane based chemotherapy regimen conducted between 1995 and 2002. Cox models were used to assess the effect of residual tumor size and further prognostic factors. Multiple imputation was used to deal with missingness in covariates.
Results
3126 pts were analysed. Approximately one third each fulfilled criteria for complete resection (group A), small residual tumor burden of 1–10mm (B), or gross residual disease exceeding 1 cm diameter (C). In multivariate analysis including patient’s and tumor characteristics A showed improved progression-free (PFS) and overall survival (OS) compared to B or C (p<0.0001). Further independent prognostic factors for OS were age, performance status, grade, stage, mucinous subtype, and ascites.
Discussion
The aim of primary surgery in every patient should be complete resection of all macroscopic tumor. Tumor biology seems to be more important in completely debulked patients than in patients with gross residual disease.
References
- 1.
- du Bois A, Lück HJ, Meier W, et al. A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. J Natl Cancer Inst 2003;95:1320-9.
- 2.
- du Bois A, Weber B, Rochon J, et al. Addition of epirubicin as a third drug to carboplatin-paclitaxel in first-line treatment of advanced ovarian cancer: a prospectively randomized gynecologic cancer intergroup trial by the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group and the Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens. J Clin Oncol 2006;24:1127-35.
- 3.
- Pfisterer J, Weber B, Reuss A, et al. Randomized phase III trial of topotecan following carboplatin and paclitaxel in first-line treatment of advanced ovarian cancer: a gynecologic cancer intergroup trial of the AGO-OVAR and GINECO. J Natl Cancer Inst 2006;98:1036-45.