Originally published as JCO Early Release 10.1200/JCO.2007.13.1953 on November 19 2007

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Tumor Residual After Surgical Cytoreduction in Prediction of Clinical Outcome in Stage IV Epithelial Ovarian Cancer: A Gynecologic Oncology Group Study

William E. Winter, III, G. Larry Maxwell, Chunqiao Tian, Michael J. Sundborg, G. Scott Rose, Peter G. Rose, Stephen C. Rubin, Franco Muggia, William P. McGuire

From the Department of Obstetrics and Gynecology, Gynecologic Oncology, Brooke Army Medical Center, Ft Sam Houston, TX; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Walter Reed Army Medical Center, Washington, DC; Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo; Division of Medical Oncology, New York University Medical Center, New York, NY; Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH; Department of Gynecologic Oncology, University of Pennsylvania Cancer Center, Philadelphia, PA; and Harry and Jeanette Weinberg Cancer Institute, Franklin Square Hospital Center, Baltimore, MD

Corresponding author: G. Larry Maxwell, MD, Division of Gynecologic Oncology, Walter Reed Army Medical Center, Rm 6743, Bldg 2, 6900 Georgia Ave, Washington, DC 20015; e-mail: george.maxwell{at}na.amedd.army.mil

Purpose To identify factors predictive of poor prognosis in a similarly treated population of women with stage IV epithelial ovarian cancer (EOC).

Patients and Methods A retrospective review of 360 patients with International Federation of Gynecology and Obstetrics stage IV EOC who underwent primary surgery followed by six cycles of intravenous platinum/paclitaxel was performed. A proportional hazards model was used to assess the association of potential prognostic factors with progression-free survival (PFS) and overall survival (OS).

Results The median PFS and OS for this group of stage IV ovarian cancer patients was 12 and 29 months, respectively. Multivariate regression analysis revealed that histology, malignant pleural effusion, intraparenchymal liver metastasis, and residual tumor size were significant prognostic variables. Whereas patients with microscopic residual disease had the best outcome, patients with 0.1 to 1.0 cm residual disease and patients with 1.1 to 5.0 cm residual disease had similar PFS and OS. Patients with a residual size more than 5 cm had a diminished PFS and OS when compared with all other groups. Median OS for microscopic, 0.1 to 5.0 cm, and more than 5.0 cm residual disease was 64, 30, and 19 months, respectively.

Conclusion Patients with more than 5 cm residual disease have the shortest PFS and OS, whereas patients with 0.1 to 1.0 and 1.1 to 5.0 cm have similar outcome. These findings suggest that ultraradical cytoreductive procedures might be targeted for selected patients in whom microscopic residual disease is achievable. Patients with less than 5.0 cm of disease initially and significant disease and/or comorbidities precluding microscopic cytoreduction may be considered for alternative therapeutic options other than primary cytoreduction.

published online ahead of print at www.jco.org on November 19, 2007.

Supported by National Cancer Institute grants to the Gynecologic Oncology Group Administrative Office (Grant No. CA 27469) and the Gynecologic Oncology Group Statistical Office (Grant No. CA 37517).

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

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