Surgery for Recurrent Ovarian Cancer: Role of Peritoneal Carcinomatosis: Exploratory Analysis of the DESKTOP I Trial About Risk Factors, Surgical Implications, and Prognostic Value of Peritoneal Carcinomatosis (original) (raw)

Abstract

Background

Almost all retrospective trials pointed out that a benefit of surgery for recurrent ovarian cancer may be limited to patients in whom a macroscopic complete resection could be achieved. Peritoneal carcinomatosis has been reported to be either a negative predictor for resectability or a negative prognostic factor, or both. The role of peritoneal carcinomatosis in a multicenter trial was investigated.

Methods

Exploratory analysis of the DESKTOP I trial (multicenter trial of patients undergoing surgery for recurrent ovarian cancer, 2000 to 2003).

Results

A total of 125 patients (50%) who underwent surgery for recurrent ovarian cancer had peritoneal carcinomatosis. Univariate analyses showed worse overall survival for patients with peritoneal carcinomatosis compared with patients without carcinomatosis (P < .0001). Patients with and without peritoneal carcinomatosis had a complete resection rate of 26% and 74%, respectively (P < .0001). This corresponded with the observation that patients with complete resection had a better prognosis than those with minimal residual disease of 1 to 5 mm, which commonly reflects peritoneal carcinomatosis (P = .0002). However, patients who underwent complete resection, despite peritoneal carcinomatosis, had a 2-year survival rate of 77%, which was similar to the 2-year survival rate of patients with completely debulked disease who did not have peritoneal carcinomatosis (81%) (P = .96). Analysis of prognostic factors did not show any independent effect of peritoneal carcinomatosis on survival in patients who underwent complete resection.

Conclusions

Peritoneal carcinomatosis was a negative predictor for complete resection but had no effect on prognosis if complete resection could be achieved. Improving surgical skills might be one step to increase the proportion of patients who might benefit from surgery for recurrent disease.

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Acknowledgments

Further members of the AGO OVAR and/or AGO Ovarian committee who contributed to this study are: J. Pfisterer (Kiel), K. Wollschlaeger (Magdeburg), H. G. Meerpohl (Karlsruhe), G. P. Breitbach (Neunkirchen), B. Tanner (Berlin), J. Sehouli (Berlin), and V. Heil (Ulm). We thank S. Eichner, A. Krüger, M. Schulze, C. Ackermann, and G. Elser (AGO-OVAR study office) for data management and technical support, and J. Rau, A. Reuss, and C. Schade-Brittinger (KKS Marburg) for statistical support.

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Authors and Affiliations

  1. Department of Gynecology and Gynecologic Oncology, HSK, Dr. Horst Schmidt Klinik, 65199, Wiesbaden, Germany
    P. Harter MD, PhD & A. du Bois MD, PhD
  2. Coordinating Center for Clinical Trials, Marburg University, Marburg, Germany
    M. Hahmann
  3. Department of Gynecology and Obstetrics, Medizinische Hochschule Hannover, Hannover, Germany
    H. J. Lueck MD, PhD
  4. Department of Gynecology and Obstetrics, Bonn University, Bonn, Germany
    M. Poelcher MD, PhD
  5. Department of Gynecology and Obstetrics, Essen University, Essen, Germany
    P. Wimberger MD, PhD
  6. Department of Gynecology and Obstetrics, Caritas St. Josef Hospital, Regensburg, Germany
    O. Ortmann MD, PhD
  7. Department of Gynecology and Obstetrics, Dresden University, Dresden, Germany
    U. Canzler MD, PhD
  8. Department of Gynecology and Obstetrics, Klinikum Radebeul, Radebeul, Germany
    B. Richter MD, PhD
  9. Department of Gynecology and Obstetrics, Marburg University, Marburg, Germany
    U. Wagner MD, PhD
  10. Department of Gynecology and Obstetrics, Freiburg University, Freiburg, Germany
    A. Hasenburg MD, PhD
  11. Department of Gynecology and Obstetrics, LMU Munich, Munich, Germany
    A. Burges MD, PhD
  12. Department of Gynecology and Obstetrics, Frankfurt University, Frankfurt, Germany
    S. Loibl MD, PhD
  13. Department of Gynecology and Obstetrics, EVK Düsseldorf, Düsseldorf, Germany
    W. Meier MD, PhD
  14. Department of Gynecology and Obstetrics, Tübingen University, Tübingen, Germany
    J. Huober MD, PhD
  15. Department of Gynecology and Obstetrics, Zurich University, Zurich, Switzerland
    D. Fink MD, PhD
  16. Department of Gynecology and Obstetrics, Klinikum Bremen Mitte, Bremen, Germany
    W. Schroeder MD, PhD
  17. Department of Gynecology and Obstetrics, Giessen University, Giessen, Germany
    K. Muenstedt MD, PhD
  18. Department of Gynecology and Obstetrics, Munchen rdI, Munchen, Germany
    B. Schmalfeldt MD, PhD
  19. Department of Gynecology and Obstetrics, Goettingen University, Goettingen, Germany
    G. Emons MD, PhD

Authors

  1. P. Harter MD, PhD
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  2. M. Hahmann
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  3. H. J. Lueck MD, PhD
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  4. M. Poelcher MD, PhD
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  5. P. Wimberger MD, PhD
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  6. O. Ortmann MD, PhD
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  7. U. Canzler MD, PhD
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  8. B. Richter MD, PhD
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  9. U. Wagner MD, PhD
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  10. A. Hasenburg MD, PhD
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  11. A. Burges MD, PhD
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  12. S. Loibl MD, PhD
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  13. W. Meier MD, PhD
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  14. J. Huober MD, PhD
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  15. D. Fink MD, PhD
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  16. W. Schroeder MD, PhD
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  17. K. Muenstedt MD, PhD
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  18. B. Schmalfeldt MD, PhD
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  19. G. Emons MD, PhD
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  20. A. du Bois MD, PhD
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Corresponding author

Correspondence toP. Harter MD, PhD.

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Harter, P., Hahmann, M., Lueck, H.J. et al. Surgery for Recurrent Ovarian Cancer: Role of Peritoneal Carcinomatosis: Exploratory Analysis of the DESKTOP I Trial About Risk Factors, Surgical Implications, and Prognostic Value of Peritoneal Carcinomatosis.Ann Surg Oncol 16, 1324–1330 (2009). https://doi.org/10.1245/s10434-009-0357-0

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