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Does Aggressive Surgery Only Benefit Patients With Less Advanced Ovarian Cancer? Results From an International Comparison Within the SCOTROC-1 Trial

From the Department of Gynaecological-Oncology, Southampton University Hospitals Trust, Southampton; Cancer Research United Kingdom, Department of Medical Oncology; Department of Gynaecological-Oncology, North Glasgow University Hospitals Trust, Glasgow, Scotland; Royal Marsden Hospital, London, United Kingdom; and Division of Oncology, Royal Brisbane and Womens' Hospital, Brisbane, Australia.

Address reprint requests to Simon C. Crawford, MD, Department of Gynaecological-Oncology, Southampton University Hospitals Trust, Southampton SO16, United Kingdom; e-mail: simon.crawford{at}suht.swest.nhs.uk

PURPOSE: Studies indicate that ovarian cancer patients who have been optimally debulked survive longer. Although chemotherapy has been variable, they have defined standards of care. Additionally, it is suggested that patients from the United Kingdom (UK) have inferior survival compared with some other countries. We explored this within the context of a large, international, prospective, randomized trial of first-line chemotherapy in advanced ovarian cancer (docetaxel-carboplatin v paclitaxel-carboplatin; SCOTROC-1). The Scottish Randomised Trial in Ovarian Cancer surgical study is a prospective observational study examining the impact on progression-free survival (PFS) of cytoreductive surgery and international variations in surgical practice.

PATIENTS AND METHODS: One thousand seventy-seven patients were recruited (UK, n = 689; Europe, United States, and Australasia, n = 388). Surgical data were available for 889 patients. These data were analyzed within a Cox model.

RESULTS: There were three main observations. First, more extensive surgery was performed in non-UK patients, who were more likely to be optimally debulked ( 2 cm residual disease) than UK patients (71.3% v 58.4%, respectively; P < .001). Second, optimal debulking was associated with increased PFS mainly for patients with less extensive disease at the outset (test for interaction, P = .003). Third, UK patients with no visible residual disease had a less favorable PFS compared with patients recruited from non-UK centers who were similarly debulked (hazard ratio = 1.85; 95% CI, 1.16 to 2.97; P = .010). This observation seems to be related to surgical practice, primarily lymphadenectomy.

CONCLUSION: Increased PFS associated with optimal surgery is limited to patients with less advanced disease, arguing for case selection rather than aggressive debulking in all patients irrespective of disease extent. Lymphadenectomy may have beneficial effects on PFS in optimally debulked patients.

Supported by Grants from Aventis Pharmaceuticals and research Grant No. K/MRS/50/C2763 (S.C.C.) from The Chief Scientist's Office (Edinburgh, United Kingdom). J.P. is funded by Cancer Research United Kingdom.

Presented in part at the 41st Annual Meeting of the American Society of Clinical Oncology, Orlando, FL, May 13-17, 2005.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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