Surgery in Recurrent Ovarian Cancer: The Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR Trial
The role of cytoreductive surgery in relapsed ovarian cancer is not clearly defined. Therefore, patient selection remains arbitrary and depends on the center’s preference rather than on established selection criteria. The Descriptive Evaluation of preoperative Selection KriTeria for OPerability in recurrent OVARian cancer (DESKTOP OVAR) trial was undertaken to form a hypothesis for a panel of criteria for selecting patients who might benefit from surgery in relapsed ovarian cancer.
The DESKTOP trial was an exploratory study based on data from a retrospective analysis of hospital records. Twenty-five member institutions of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee (AGO OC) and AGO-OVAR boards collected data on their patients with cytoreductive surgery for relapsed invasive epithelial ovarian cancer performed in 2000–2003.
Two hundred and sixty-seven patients were included. Complete resection was associated with significantly longer survival compared with surgery leaving any postoperative residuals [median 45.2 vs. 19.7 months; hazard ratio (HR) 3.71; 95% confidence interval (CI) 2.27–6.05; P < .0001]. Variables associated with complete resection were performance status (PS) [Eastern Cooperative Oncology Group (ECOG) 0 vs. > 0; P < .001], International Federation of Gynecology and Obstetrics (FIGO) stage at initial diagnosis (FIGO I/II vs. III/IV, P = .036), residual tumor after primary surgery (none vs. present, P <.001), and absence of ascites > 500 ml (P < .001). A combination of PS, early FIGO stage initially or no residual tumor after first surgery, and absence of ascites could predict complete resection in 79% of patients.
Only complete resection was associated with prolonged survival in recurrent ovarian cancer. The identified criteria panel will be verified in a prospective trial (AGO-DESKTOP II) evaluating whether it will render a useful tool for selecting the right patients for cytoreductive surgery in recurrent ovarian cancer.
KeywordsOvarian cancer Ovarian neoplasm Recurrence Secondary cytoreductive surgery
*Further members of the study coordinating group of the AGO OVAR and/or the AGO OC who contributed to this study are (in alphabetic order): U. Canzler (Dresden), V. Heilmann (Ulm), C. Jackisch (Marburg), W. Kuhn (Bonn), H.J. Lueck (Hannover), O. Ortmann (Regensburg), B. Richter (Radebeul), I. Runnebaum (Jena), P. Wimberger (Essen).
The authors thank S. Eichner, A. Krüger, M. Schulze (AGO-OVAR study office Kiel, Germany), and C. Ackermann, G. Elser (AGO-OVAR central unit Wiesbaden, Germany) for data management and technical support, and J. Rochon and C. Schade-Brittinger (KKS Marburg, Germany) for statistical support. This work is dedicated to Helge Prinz who was recently deceased. He was a mentor and statistical consultant for the AGO DESKTOP series, and we will continue this series in his memory.
- 4.van der Burg ME, van Lent M, Buyse M, et al. The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. Gynecological Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. NEJM 1995; 332:629–34PubMedCrossRefGoogle Scholar
- 9.SAS Institute, Inc., Cary, NCGoogle Scholar
- 13.Pfisterer J, Plante M, Vergote I, et al. Gemcitabine/carboplatin vs. carboplatin in platinum sensitive recurrent ovarian cancer. Results of a Gynecologic Cancer Intergroup randomized phase III trial of the AGO OVAR, the NCIC CTG and the EORTC GCG. Proc Am Soc Clin Oncol 2004; 449:23, (abstr 5005)Google Scholar
- 15.Gonzalez-Martin AJ, Calvo E, Bover I, et al. Randomized phase II trial of carboplatin versus paclitaxel and carboplatin in platinum-sensitive recurrent advanced ovarian carcinoma: a GEICO (Grupo Espanol de Investigacion en cancer de ovario) study. Ann Oncol 2005; 16:749–55PubMedCrossRefGoogle Scholar
- 17.Loehr A, Harter P, Traut A, Gnauert K, du Bois A. Cytoreductive surgery in recurrent ovarian cancer. J Cancer Res Clin Oncol 2004; 130(suppl. 1):S122 (abstract)Google Scholar