Objective: The objective of this study was to identify independent prognostic factors for survival in patients with epithelial ovarian cancer who had persistent disease identified at second-look surgery.
Methods: We performed a retrospective chart review of all patients with epithelial ovarian cancer who had positive findings at second-look surgery between June 1991 and June 2002. All patients achieved a complete clinical remission after a prescribed course of primary therapy. Survival was determined from the time of second-look surgery until last follow-up or death.
Results: The study included a total of 262 patients, with a median age of 54 years (range, 22-80). Of the 262 patients, 166 (63%) had died of disease. Records of initial (salvage) treatment after the positive second-look surgery were available for 243 patients. Therapies included the following: intraperitoneal (IP) cisplatin, 71 (29%); IP cisplatin combined with a second drug, 53 (22%); IP therapy other than cisplatin, 29 (12%); intravenous (IV) chemotherapy, 50 (21%); IP and IV therapy, 35 (14%); and oral chemotherapy, 5 (2%). Of the 13 potential prognostic factors analyzed, only 2 factors emerged that, when combined, were significant--residual disease after primary surgery and size of persistent disease found at second-look surgery. Patients with <or=1 cm residual disease after primary surgery and microscopic disease at second-look surgery had significantly improved survival.
Conclusion: In our analysis, the only prognostic factor for survival in patients with positive second-look procedures was a combination of residual disease after primary surgery and size of persistent disease identified at second-look surgery. No individual chemotherapy treatment imparted a survival advantage. Novel that therapeutic approaches are needed in this setting.