Prognostic impact of debulking surgery and residual tumor in patients with epithelial ovarian cancer FIGO stage IV

Objective. To determine the impact of debulking surgery (DS) and residual disease (RD) on outcome in patients with FIGO stage IV epithelial ovarian cancer (EOC). Patients and methods. This exploratory study included 326 consecutive patients with FIGO IV EOC treated in our centers from 2000 to 2014. Data were extracted from our prospectively maintained registry. Results. In patients, who underwent DS (n = 286; 87.7%), complete macroscopic resection was achieved in 54.9% (RDO; n = 157), RD of 1-10 mm in 30.8% (RD1-10; n = 88), and RD of >10 mm in 14.3% (RD > 10, n = 41). Forty patients without surgery (NoCS; 12.3%) underwent either primary chemotherapy or palliative care only. Median overall survival (OS) in NoCS was 19 months compared to 16, 25, and 50 months in RD > 10, RD1-10, and RDO, respectively (p < 0.001). Multivariate analysis confirmed an inferior OS for NoCS (HR 2.51, 95% CI 1.25-3.57; p = 0.001), RD > 10 (HR 2.17, 95% CI 1.43-3.70; p = 0.002), and RD1-10 (HR 1.50, 95% CI 1.01-2.23; p = 0.046) when compared with RDO. Additional independent prognostic factors were poor performance status, ascites >500 mL, and advanced intraabdominal tumor stage. Conclusion. Our results confirm the prognostic impact of optimal DS in FIGO stage IV disease. Survival benefit was greatest for patients with complete resection. Although not to the same extent patients do benefit from DS with RD:510 mm. Of note, patients with RD > 10 mm after DS seemed not to profit from surgery showing comparable OS to patients without DS. Selecting patients who benefit from DS is as crucial in stage IV EOC patients as it is in any other patients with advanced EOC. (C) 2015 Elsevier Inc. All rights reserved.