The effect of maximal surgical cytoreduction on sensitivity to platinum-taxane chemotherapy and subsequent survival in patients with advanced ovarian cancer

Objective. In advanced ovarian cancer, patients cytoreduced to no visible disease appear to have improved survival compared to patients with visible residual tumor <= 10 mm. It remains unresolved whether this is due to better chemotherapy response and/or simply "re-setting the clock," such that patients with less residual disease take longer to recur and succumb to their disease. Methods. We reviewed the records of all patients who had primary surgery for stage IIIC-IV ovarian cancer at our institution from 1998-2004, followed by intravenous platinum-taxane chemotherapy. Primary outcome measures were complete response (CR) to initial chemotherapy, platinum resistance at 6 months, progression-free (PFS), and overall survival (OS). Results. A total of 296 patients met study criteria, of whom 64 (22%) had cytoreduction to no visible disease, 145 (49%) had 1-10 mm residual disease, and 87 (29%) had > 10 mm residual disease. After multivariate analyses, patients cytoreduced to no visible disease demonstrated significant improvements in rates of initial complete response and incidence of platinum resistance, as well as subsequent improvement in PFS and OS, compared to the other two groups. Similarly, patients with 1-10 mm residual disease, had improved outcomes compared to patients with > 10 mm residual disease for each endpoint. Conclusions. In ovarian cancer patients with < 10 mm residual disease who began platinum-taxane therapy, maximal cytoreduction to no visible residual disease was associated with improved initial chemotherapy response, less platinum resistance, and improved survival. Maximal cytoreduction may improve survival through increased sensitivity to initial chemotherapy and should be the goal of initial surgery in these patients. 2007 Elsevier Inc. All rights reserved.