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

- Residual disease (RD) after debulking surgery impacts prognosis in stage FIGO IV ovarian cancer.
- Complete tumor resection leads to largest survival benefit.
- Lesser benefit is gained for patients with RD of 1-10 mm.
- Patients with RD of > 10 mm do not benefit from cytoreductive surgery.

ObjectiveTo 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 methodsThis 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.ResultsIn patients, who underwent DS (n = 286; 87.7%), complete macroscopic resection was achieved in 54.9% (RD0; 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 RD0, 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 RD0. Additional independent prognostic factors were poor performance status, ascites > 500 mL, and advanced intraabdominal tumor stage.ConclusionOur 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 ≤ 10 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.