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The Value of Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer and Application of a Prognostic Score
  1. Alexandre Andre Balieiro Anastacio da Costa, MD*,
  2. Camila V. Valadares, MD*,
  3. Henrique Mantoan, MD,
  4. Augusto Saito, MD*,
  5. Marcella Marinelli Salvadori, MD*,
  6. Andreia Paiva Guimarães, MD,
  7. Solange Moraes Sanches, MD*,
  8. Maria Isabel Alves de Souza Wadington Achatz, MD, PhD and
  9. Glauco Baiocchi, MD, PhD
  1. *Medical Oncology Department,
  2. Gynecology Oncology Department, and
  3. Oncogenetics Department, AC Camargo Cancer Center, Sao Paulo, SP, Brazil.
  1. Address correspondence and reprint requests to Alexandre Andre Balieiro Anastacio da Costa, MD, Medical Oncology Department, AC Camargo Cancer Center, 211 Professor Antonio Prudente St, Liberdade, Sao Paulo, SP 01509-900, Brazil. E-mail:


Objectives Secondary cytoreductive surgery (SCS) is an option for treating patients with recurrent ovarian cancer. Three ongoing randomized trials are comparing SCS plus chemotherapy with chemotherapy alone, and few comparative studies have been published.

Materials and Methods We performed a retrospective review of data on 209 patients with recurrent ovarian carcinoma who were treated at a single institution from 2000 to 2013. We analyzed prognostic factors in the recurrence setting to determine the value of SCS in a multivariate model, including propensity score, by prognostic group.

Results In the univariate analysis, younger than 65 years, personal or family history of breast or ovarian cancer, stage I–II at diagnosis, residual disease 10 mm or less after primary debulking surgery, performance status 1 or less, CA125 less than 100, only 1 metastatic site of recurrence, platinum-free interval of more than 12 months, and SCS correlated with better overall survival. In the multivariate model, including propensity score, SCS remained associated with a 66% decrease in the risk of death (hazard ratio, 0.34; 95% CI, 0.15–0.76, P = 0.008). Secondary cytoreductive surgery was also linked to longer progression-free survival (hazard ratio, 0.50; 95% CI, 0.30–0.84, P = 0.008). There was no evidence of a benefit of SCS in patients with unfavorable prognosis (P for interaction = 0.654).

Conclusions Our results confirm the benefit of SCS in progression-free survival and overall survival in the recurrent setting and suggest that it exists not only for patients with a good prognosis.

  • Ovarian carcinoma
  • Secondary cytoreductive surgery
  • Prognostic groups

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  • The authors declare no conflicts of interest.

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