Purpose: The aim of this study was to investigate whether preoperative laparoscopic evaluation of the dissemination of disease may have an independent impact on survival in advanced epithelial ovarian cancer (AEOC).
Methods: All AEOC women were submitted to staging laparoscopy before receiving primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT). All study women received a laparoscopic score (predictive index value [PIV]) and were stratified into three groups based on volume of disease: high tumor load (HTL) for PIV ≥8, intermediate tumor load (ITL) for PIV equal to 6 and 4, and low tumor load (LTL) for PIV <4. Surgical and survival outcome were evaluated by univariate and multivariate analysis.
Results: Among 348 consecutive patients, almost half (48.0 %) had an HTL. Among 165 cases receiving PDS, residual tumor (RT) was as follows: no gross residual in 102 patients (61.8 %); RT ≤1 cm in 48 patients (29.1 %) and RT >1 cm in 15 cases (9.1 %). When stratifying the whole population according to laparoscopic tumor load, the median progression-free survival (PFS) was 33 months for LTL, 18 months for ITL, and 14 months for HTL (p = 0.0001). The median overall survival (OS) with respect to laparoscopic PIV was not reached for LTL, whereas it was 47 months for ITL and 33 months for HTL, respectively (p = 0.0001). At multivariate analysis, tumor load stratified by PIV retained an independent prognostic value on PFS and OS, together with RT and performance status.
Conclusions: RT remains an important prognostic factor in patients with AEOC, but tumor dissemination can play a role in determining prognosis in these women.