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Prognostic Factors and Clinical Outcome of Patients With Recurrent Early-Stage Epithelial Ovarian Cancer: An Italian Multicenter Retrospective Study

Gadducci, Angiolo MD*; Cosio, Stefania MD*; Zola, Paolo MD; Sostegni, Benedetta MD; Fuso, Luca MD; Sartori, Enrico MD

International Journal of Gynecological Cancer: March 2013 - Volume 23 - Issue 3 - p 461–468
doi: 10.1097/IGC.0b013e318286665b
Ovarian Cancer

Objective: The objective of this study was to assess the clinical outcome of patients with recurrent early-stage ovarian cancer.

Methods: The hospital records of 87 patients were reviewed. The median follow-up of survivors from recurrence was 87.6 months.

Results: The 25%, 50%, and 75% quantiles of time to recurrence were 15, 25, and 44 months, respectively. The pelvis was the most common site of failure (39.1%), followed by abdomen (18.3%) and retroperitoneal nodes (18.3%). Treatment at recurrence consisted of chemotherapy in 46 patients, surgery plus chemotherapy in 29, surgery in 3, surgery plus radiotherapy in 2, and other therapies in 7. A macroscopically complete cytoreduction was obtained in 29 (85.2%) of the 34 patients who underwent secondary surgery. Five- and 7-year survival rates after recurrence were 34.3% and 29.6%. By log-rank test, survival after recurrence was related to patient age (≤60 vs >60 years; P = 0.001), time to recurrence (>15 vs ≤15 months; P = 0.049), site of recurrence (retroperitoneum vs pelvis vs other; P = 0.004), and surgery at recurrence (yes vs not; P = 0.001), but not to substage, histotype, grade, prior adjuvant chemotherapy, examination that detected recurrence, and chemotherapy at recurrence. On multivariate analysis, patient age (hazard ratio, 1.836; 95% confidence interval, 1.060-3.180) and surgical treatment at recurrence (hazard ratio, 1.972; 95% confidence interval, 1.084–3.587) were independent prognostic variables for survival after recurrence.

Conclusions: Patient age and surgery at recurrence were independent prognostic variables for patients with recurrent early-stage ovarian cancer. When feasible, salvage surgery appears to give a survival advantage in this clinical setting.

*Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa; †Department of Gynecology and Obstetrics, University of Turin; and ‡Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy.

Address correspondence and reprint requests to Angiolo Gadducci, MD, Division of Clinical and Experimental Medicine, University of Pisa, Via Roma 56, Pisa, 56127, Italy; E-mail: a.gadducci@obgyn.med.unipi.it.

The authors declare no conflicts of interest.

Received October 3, 2012

Accepted January 7, 2013

Copyright © 2013 by IGCS and ESGO