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Original research
Impact of residual disease at interval debulking surgery on platinum resistance and patterns of recurrence for advanced-stage ovarian cancer
  1. Anna Greer1,2,
  2. Allison Gockley2,3,
  3. Beryl Manning-Geist1,2,
  4. Alexander Melamed4,
  5. Rachel Clark Sisodia1,
  6. Ross Berkowitz2,3,
  7. Neil Horowitz2,3,
  8. Marcela Del Carmen1,
  9. Whitfield B Growdon1 and
  10. Michael Worley Jr2,3
  1. 1Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  3. 3Dana-Farber Cancer Institute, Boston, Massachusetts, USA
  4. 4Department of Gynecologic Oncology, Columbia University Irving Medical Center, New York, New York, USA
  1. Correspondence to Dr Anna Greer, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA 02115, USA; acgreer{at}partners.org

Abstract

Objective To evaluate the impact of size and distribution of residual disease after interval debulking surgery on the timing and patterns of recurrence for patients with advanced-stage epithelial ovarian cancer.

Methods Patient demographics and data on disease treatment/recurrence were collected from medical records of patients with stage IIIC/IV epithelial ovarian cancer who were managed with neoadjuvant chemotherapy/interval debulking surgery between January 2010 and December 2014. Among patients without complete surgical resection but with ≤1 cm of residual disease, the number of anatomic sites (<1 cm single anatomic location vs <1 cm multiple anatomic locations) was used to describe the size and distribution of residual disease. 

Results A total of 224 patients were included. Of these, 70.5% (n=158) had a complete surgical resection, 12.5% (n=28) had <1 cm single anatomic location, and 17.0% (n=38) had <1 cm multiple anatomic locations. Two-year progression-free survival for complete surgical resection, <1 cm single anatomic location, and <1 cm multiple anatomic locations was 22.2%, 17.9% and 7%, respectively (p=0.007). Size and distribution of residual disease after interval debulking surgery did not affect location of recurrence and most patients had recurrence at multiple sites (complete surgical resection: 64.7%, <1 cm single anatomic location: 55.6%, and <1 cm multiple anatomic locations: 71.4%). Controlling for additional factors that may influence platinum resistance and surgical complexity, the rate of platinum-resistant recurrence was similar for patients with complete surgical resection and <1 cm single anatomic location (OR=1.07, 95% CI 0.40 to 2.86; p=0.888), but women with <1 cm multiple anatomic locations had an increased risk of platinum resistance (OR=3.09, 95% CI 1.41 to 6.78 p=0.005).

Conclusions Despite current classification as ‘optimal,’ <1 cm multiple anatomic location at the time of interval debulking surgery is associated with a shorter progression-free survival and increased risk of platinum resistance.

  • ovarian cancer
  • surgical oncology

Data availability statement

Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for the reproducibility of this study in other centers if such is requested.

https://doi.org/10.1136/ijgc-2020-001505

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    Data availability statement

    Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for the reproducibility of this study in other centers if such is requested.

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    Footnotes

    • Contributors ACG: concept development, primary data collection, data analysis, manuscript author; AG, AM: data analysis, manuscript editing; BM-G: data collection, manuscript editing; RCS, RB. NH, MDC, WBG: research mentor, manuscript editing; MW: institutional review board submission, concept development, primary research mentor, manuscript editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MW: receives financial support as a member of the Surgical Advisory Board for CONMED Corporation. Other authors: no conflict of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.