Cytoreductive surgery has been shown to be an independent predictor of the overall survival of advanced ovarian cancer patients.
A retrospective, case-control study presented at the Society of Gynecologic Oncology’s Virtual Annual Meeting on Women’s Cancer revealed the effectiveness of cytoreductive surgery for advanced ovarian cancer, even in patients who are not responding to chemotherapy.
Nicholas Cardillo, MD and gynecologic oncology fellow at the University of Iowa, presented the findings of the study, explaining that a patient’s poor response to chemotherapy sometimes justifies the decision to refrain from cytoreductive surgery because the patient’s response to chemotherapy is the strongest of all predictors of overall survival in advanced cases of ovarian cancer.
The practice of forgoing cytoreductive surgery led Cardillo and his fellow researchers to explore the matter in greater depth. They found that the surgical removal of all cancerous tissue of 1 cm or more improved survival rates no matter the patient’s response to chemotherapy.
The team of researchers examined data on 234 patients with stage III or IV high-grade serous ovarian cancer, which is the most malignant form of the cancer. Each of these patients had responded to platinum-based chemotherapy, so no disease was evident for a minimum of six months after chemotherapy treatment. They also collected data on 98 patients who did not respond to chemotherapy. These patients showed signs of progress during therapy, stable disease, incomplete response to the treatment, or less than six progression-free months. Only seven patients in each group experienced less than six cycles of chemotherapy.
Approximately 75% of responders to chemotherapy, who had a mean age of 59, and 57% of nonresponders, who had a mean age of 62, had optimal surgery. More nonresponders had Stage IV cancer that involved the upper abdomen and chest.
The responder group had a median overall survival of 44.8 months while the nonresponders had 18.1 months (P < .001). Patients who had optimal surgery had a mean overall survival of 34.2 months while those who did not have surgery had 24.8 months.
Optimal surgery proved to be a significant independent predictor of overall survival, though response to the chemotherapy had the most significant impact on survival according to a multivariate analysis, with a hazard ratio of 0.27 (P < .001).
Cardillo explained that hazard ratio is 0.73 [P = .023], which shows a 25%-30% improvement in overall survival, even when controlling for other risk factors like a patient’s response to chemotherapy.
These improvements in overall survival mean that, if at all possible, cytoreductive surgery should be considered for the treatment of ovarian cancer patients who respond poorly to chemotherapy.
Cardillo followed his recommendation that all patients with ovarian cancer undergo cytoreduction, also known as debulking surgery, with an acknowledgement that later research findings may impact his recommendations. For now, however, in light of this recent study, no evidence can be found to discourage cytoreductive surgery in patients with ovarian cancer.
