Abstract

The objective of this paper is to clarify the role of cytoreductive surgery and salvage chemotherapy in the management of recurrent advanced epithelial ovarian carcinoma (RAEOC) and to identify factors affecting disease recurrence. One hundred sixty seven patients with RAEOC treated at the Cancer Hospital of Fudan University between January 1986 and December 1997 were retrospectively reviewed. Survival was calculated by Kaplan-Meier method with difference in survival estimated by the log-rank test. Independent prognostic factors were identified by the Cox stepwise regression model and variants associated with disease recurrence were determined using logistic stepwise regression methods. The median age was 52 (range 27–72) years. Sixty (35.9%) patients underwent re-debulking surgery, 23 of them with residual disease ≤1 cm. There was a significant difference in survival between optimal and suboptimal groups, with an estimated median survival of 18 and 13 months, respectively (P = 0.021, χ² = 9.42). When patients with suboptimal surgical results were compared to those with chemotherapy alone, there was a significant difference in median survival, 13 vs. 16 months (P = 0.0364, χ² = 4.38). Residual disease after primary surgery, neoadjuvant chemotherapy, and salvage chemotherapy was a predictor of survival identified by Cox regression analysis, but secondary cytoreductive surgery did not reach a level of statistical significance (P = 0.0561). Logistic stepwise regression analysis showed that age, first-line chemotherapy, neoadjuvant chemotherapy, and the size of residual disease after primary surgical cytoreduction were factors affecting disease recurrence. We conclude that patients with RAEOC benefit from optimal secondary surgical cytoreduction. Should the recurrence not be optimally cytoreduced by surgery, alternative salvage chemotherapy is best for RAEOC.