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Secondary Surgery Versus Chemotherapy for Recurrent Ovarian Cancer

Bickell, Nina, A., MD, MPH*; Egorova, Natalia, PhD*; Prasad-Hayes, Monica, MD; Franco, Rebeca, MPH*; Howell, Elizabeth, A., MD, MPP*; Wisnivesky, Juan, MD, DrPH; Deb, Partha, PhD§

American Journal of Clinical Oncology: May 2018 - Volume 41 - Issue 5 - p 458–464
doi: 10.1097/COC.0000000000000310
Original Articles: Gynecologic

Objective: The best course of treatment for recurrent ovarian cancer is uncertain. We sought to determine whether secondary cytoreductive surgery for first recurrence of ovarian cancer improves overall survival compared with other treatments.

Materials and Methods: We assessed survival using Surveillance, Epidemiology and End Results-Medicare data for advanced stage ovarian cancer cases diagnosed from January 1, 1997 to December 31, 2007 with survival data through 2010 using multinomial propensity weighted finite mixture survival regression models to distinguish true from misclassified recurrences. Of 35,995 women ages 66 years and older with ovarian cancer, 3439 underwent optimal primary debulking surgery with 6 cycles of chemotherapy; 2038 experienced a remission.

Results: One thousand six hundred thirty-five of 2038 (80%) women received treatment for recurrence of whom 72% were treated with chemotherapy only, 16% with surgery and chemotherapy and 12% received hospice care. Median survival of women treated with chemotherapy alone, surgery and chemotherapy, or hospice care was 4.1, 5.4, and 2.2 years, respectively (P<0.001). Of those receiving no secondary treatments, 75% were likely true nonrecurrences with median survival of 15.9 years and 25% misclassified with 2.4 years survival. Survival among women with recurrence was greater for those treated with surgery and chemotherapy compared with chemotherapy alone (hazard ratio=1.67; 95% confidence interval, 1.13-2.47). Women who were older with more comorbidities and high-grade cancer had worse survival.

Conclusions: Secondary surgery with chemotherapy to treat recurrent ovarian cancer increases survival by 1.3 years compared with chemotherapy alone and pending ongoing randomized trial results, may be considered a standard of care.

Departments of *Population Health Science and Policy, and Medicine

Obstetrics, Gynecology and Reproductive Science

Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

§Department of Economics, Hunter College, NY

Supported by NCI 5R01CA157176.

J.W. is a member of the research board of EHE International, has received consulting honorarium from Merck, BMS, and Quintiles and research grants from Aventis and Quorum. The other authors declare no conflicts of interest.

Reprints: Nina A. Bickell, MD, MPH, Department of Population Health Science and Policy, and Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1077, New York, NY 10029. E-mail: nina.bickell@mssm.edu.

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