The significance of abdominal residue after primary cytoreductive surgery forst age Ⅲ ovarian cancer / 中国癌症杂志

ABSTRACT

Purpose:To evaluate the significance of abdominal residue after primary cytoreductive su rgery for stage Ⅲ ovarian cancer.Methods:From Nov 1990 to Nov 1996, 57 patients with stage Ⅲ ovarian cancer who underwen t primary cytoreduction in our hospital and their residual disease were analyzed , with mean age of 51.9 (23～74). 20 patients achieved optimal cytoreduction (th e largest residual tumor ≤ 1cm). 9 patients had no gross residual tumor after s urgery, 37 cases had residual disease both in the abdomen and pelvis. Abdominal residual disease was found in 7 cases and pelvic residual disease in 4 cases. 30 cases were given chemotherapy before surgery. After primary surgery, 36 patient s received a mean of 3 courses of intraperitoneal chemotherapy and 46 patients were treated with a mean of 4 cycles of platinum-based intravenous chemotherapy . Complete remission were achieved in 32 cases (56.1%).Results:With a mean follow-up of 29.1 months (0.3～109.1months), 1-5 year survival rat es were 79.82%, 57.59%, 49.06%, 39.93%, 23.41%, respectively. Univariate analysi s indicated stage (P=0.0283), size of residual disease (P=0.0041), resid ue in the abdomen (P=0.0362), type of surgery (P=0.0337) and intraperito neal chemotherapy after surgery (P=0.0469) influenced survival. Multivariate analysis suggested that size of residual disease (P=0.0025), intraperiton eal chemotherapy (P=0.0323) and intravenous chemotherapy (P=0.0297)aft er surgery were independent prognostic factors of survival. Those patients who h ad no macroscopic residual lesion in the abdomen after cytoreducion had a better survival, with estimated median survival of 58.0 months vs 22.7 months for pati ents with abdominal residue (P=0.0362), with 3-year, 5-year survival rate of 83.64% vs 37.60% and 29.57% vs 21.05%, respectively. Residual disease in the pelvis did not affect the survival (P=0.2782). For patients with abdominal r esidue after surgery, optimal abdominal cytoreduction predicted increased surviv al (P=0.0319), while optimal pelvic cytoreduction predicted increased progre ss-free survival (P=0.0104). Stage(P=0.041), chemotherapy before surg ery(P=0.009)and pathologic classification(P=0.042)were determinants for abdominal residue after cytoreduction.Conclusions:The size of residual disease and abdominal residue after cytoreduction affected the progn osis for stage Ⅲ ovarian cancer. Patients with abdominal residue suffered a pes simistic outcome. Residual lesions in the abdomen influenced the patients' surv ival, while pelvic residue affected progress-free survival.