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527 Survival dynamics in advanced ovarian cancer: R2 resection versus no-surgery paths explored
  1. Konstantinos Pitsikakis1,
  2. Konstantinos Kitsos-Kalyvianakis1,
  3. Michela Quaranta1,
  4. Marios Evangelos Mamalis2,
  5. Ganiy Abdulrahman1,
  6. Sarika Munot1,
  7. Amudha Thangavelu1,
  8. Evangelos Kalampokis2,
  9. Timothy Broadhead1,
  10. David Nugent1,
  11. Alexandros Laios1 and
  12. Diederick Dejong1
  1. 1Department of Gynaecologic Oncology, ESGO Centre of Excellence for ovarian cancer surgery, St James’s University Hospital, Leeds, UK
  2. 2Information Systems Lab, Department of Business Administration, University of Macedonia, Thessaloniki, Greece


Introduction/Background Cytoreductive surgery is critical for optimal tumour clearance in advanced epithelial ovarian cancer (EOC). Despite best efforts, some patients may experience R2 (>1cm) resection, while others may not undergo surgery at all. We aimed to compare outcomes between advanced EOC patients undergoing R2 resection and those who had no surgery.

Methodology Retrospective data from 51 patients with R2 resection were compared to 122 patients with no surgery between January 2015 and December 2019 at a UK tertiary referral centre. Progression-free survival (PFS) and overall survival (OS) were the study endpoints. Principal Component Analysis (PCA) and Term Frequency – Inverse Document Frequency (TF-IDF) score were utilized for data discrimination and prediction of R>2cm from CT pre-operative reports, respectively.

Results No statistical significance was observed, except for age (73 vs. 67 years in the no-surgery vs. R2 group, P: 0.001). Principal Components explained 34% of data variances. Reasons for no surgery included age, co-morbidities, patient preference, refractory disease, patient deterioration or disease progression, and absence of measurable intra-abdominal disease). The 5-year PFS and OS were 12 and 14 months for no-surgery, vs. 14 and 26 months for R2 (P: 0.138 and P: 0.001, respectively). Serous histology and performance status independently predicted PFS in both no-surgery and R2 cohorts. In the no-surgery cohort, serous histology independently predicted overall survival (OS), while in the R2 cohorts, both serous histology and adjuvant chemotherapy were independent prognostic features for OS. The bi-grams ‘omental disease’, ‘reduced bulk’ best discriminated between R>2cm and R1–2cm.

Conclusion R2 resection and no-surgery cohorts displayed unfavourable prognosis with notable degree of uniformity. Patients who opt for the no-surgery route should be aware that cytoreductive surgery significantly extends OS but not PFS. The recommendation against R2 resection in women with serous histology underscores the importance of anticipating this outcome through pre-operative imaging.

Disclosures There are no conflicts of interest.

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