The clinical outcome of epithelial ovarian cancer patients with apparently isolated lymph node recurrence: A multicenter retrospective Italian study Angiolo Gadducci a,⁎, Stefania Cosio a, Paolo Zola b, Benedetta Sostegni c, Anna Maria Ferrero b, Giancarlo Teti a, Renza Cristofani d, Enrico Sartori c a Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Via Roma 56, Pisa, 56127, Italy b Department of Gynecology and Obstetrics, University of Turin, Mauriziano Hospital, Turin, Italy c Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy d Department of Experimental Pathology, University of Pisa, Pisa, Italy a r t i c l e i n f o a b s t r a c t Article history: Received 3 September 2009 Available online 1 December 2009 Keywords: Epithelial Ovarian cancer Prognostic variable Lymph node recurrence Chemotherapy Secondary surgical cytoreduction Objectives. To assess the clinical outcome of epithelial ovarian cancer patients who developed an apparently isolated lymph node recurrence after primary therapy. Methods. The authors retrospectively assessed 69 patients with epithelial ovarian cancer who were clinically or pathologically free of disease after primary therapy and who subsequently developed an apparently isolated lymph node recurrence. The median follow-up of survivors was 74.5 months. Results. Median age was 58 years, FIGO stage was III–IV in 52 (75%) patients, residual disease after primary surgery was N1 cm in 36 (52%), first-line chemotherapy consisted of paclitaxel-/platinum-based chemotherapy in 44 (64%), time to recurrence was N12 months in 43 (62%), recurrence was pelvic and/or para-aortic in 41 (59%), and treatment at recurrence consisted of chemotherapy alone in 44 (64%), surgery plus chemotherapy in 22 (32%), surgery alone in one patient, surgery plus irradiation in one, and irradiation alone in one patient. Survival after recurrence was significantly related to the type of treatment (chemotherapy alone versus surgery plus chemotherapy, median: 20.8 months versus not reached, p=0.0002), and patient age (N58 versus b58 years, median: 26.8 versus 44.0 months, p=0.02). Overall survival was significantly related to the type of treatment (chemotherapy alone versus surgery plus chemotherapy, median: 45.4 months versus not reached, p=0.0001), patient age (N58 versus b58 years, median: 45.4 versus 62.9 months, p=0.03) and time to recurrence (b12 months versus N12 months, median: 45.4 versus 66.9 months, p=0.01). Cox model showed that treatment at recurrence was the strongest independent prognostic variable for both survival after recurrence (hazard ratio [HR]=0.277, p=0.0003) and overall survival (HR=0.249, p=0.0002). Conclusion. Patients who underwent surgery plus chemotherapy had a 72% reduction in the risk of death after recurrence and a 75% reduction in the risk of death after initial diagnosis when compared with those treated with chemotherapy alone. Secondary cytoreductive surgery appears to be able to prolong survival in epithelial ovarian cancer patients with apparently isolated lymph node recurrence. © 2009 Elsevier Inc. All rights reserved.
The clinical outcome of epithelial ovarian cancer patients with apparently isolated lymph node recurrence: a multicenter retrospective Italian study
GADDUCCI, ANGIOLO;CRISTOFANI, RENZA;
2010-01-01
Abstract
The clinical outcome of epithelial ovarian cancer patients with apparently isolated lymph node recurrence: A multicenter retrospective Italian study Angiolo Gadducci a,⁎, Stefania Cosio a, Paolo Zola b, Benedetta Sostegni c, Anna Maria Ferrero b, Giancarlo Teti a, Renza Cristofani d, Enrico Sartori c a Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Via Roma 56, Pisa, 56127, Italy b Department of Gynecology and Obstetrics, University of Turin, Mauriziano Hospital, Turin, Italy c Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy d Department of Experimental Pathology, University of Pisa, Pisa, Italy a r t i c l e i n f o a b s t r a c t Article history: Received 3 September 2009 Available online 1 December 2009 Keywords: Epithelial Ovarian cancer Prognostic variable Lymph node recurrence Chemotherapy Secondary surgical cytoreduction Objectives. To assess the clinical outcome of epithelial ovarian cancer patients who developed an apparently isolated lymph node recurrence after primary therapy. Methods. The authors retrospectively assessed 69 patients with epithelial ovarian cancer who were clinically or pathologically free of disease after primary therapy and who subsequently developed an apparently isolated lymph node recurrence. The median follow-up of survivors was 74.5 months. Results. Median age was 58 years, FIGO stage was III–IV in 52 (75%) patients, residual disease after primary surgery was N1 cm in 36 (52%), first-line chemotherapy consisted of paclitaxel-/platinum-based chemotherapy in 44 (64%), time to recurrence was N12 months in 43 (62%), recurrence was pelvic and/or para-aortic in 41 (59%), and treatment at recurrence consisted of chemotherapy alone in 44 (64%), surgery plus chemotherapy in 22 (32%), surgery alone in one patient, surgery plus irradiation in one, and irradiation alone in one patient. Survival after recurrence was significantly related to the type of treatment (chemotherapy alone versus surgery plus chemotherapy, median: 20.8 months versus not reached, p=0.0002), and patient age (N58 versus b58 years, median: 26.8 versus 44.0 months, p=0.02). Overall survival was significantly related to the type of treatment (chemotherapy alone versus surgery plus chemotherapy, median: 45.4 months versus not reached, p=0.0001), patient age (N58 versus b58 years, median: 45.4 versus 62.9 months, p=0.03) and time to recurrence (b12 months versus N12 months, median: 45.4 versus 66.9 months, p=0.01). Cox model showed that treatment at recurrence was the strongest independent prognostic variable for both survival after recurrence (hazard ratio [HR]=0.277, p=0.0003) and overall survival (HR=0.249, p=0.0002). Conclusion. Patients who underwent surgery plus chemotherapy had a 72% reduction in the risk of death after recurrence and a 75% reduction in the risk of death after initial diagnosis when compared with those treated with chemotherapy alone. Secondary cytoreductive surgery appears to be able to prolong survival in epithelial ovarian cancer patients with apparently isolated lymph node recurrence. © 2009 Elsevier Inc. All rights reserved.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
