SURVIVAL OF WOMEN WITH ADVANCED OVARIAN-CANCER AND COMPLETE PATHOLOGICAL RESPONSE AT 2ND-LOOK LAPAROTOMY

BAGKGROUND. The purpose of the study was to analyze the determinants o f long term survival in women with advanced ovarian cancer and negativ e second-look laparotomy. METHODS. A series of 140 advanced (Stage III -IV) ovarian cancer patients (median age, 54 years; range, 22-74 years ) with negative second-look laparotomy after primary surgery and chemo therapy is included in the analysis. At first diagnosis, all patients were treated with radical or debulking surgery. After primary surgery, the patients were treated with a chemotherapy regimen based on cispla tin or carboplatin alone or in combination with other drugs. All secon d-look laparotomies were performed 6-8 months after first surgery. RES ULTS. The overall survival rates were 76% at 3 years, 66% at 5 years, and 51% at 8 years. The corresponding rates for disease free survival were 57, 50, and 43%, respectively. Survival rates were better for wom en with a residual tumor 1 cm or less after primary surgery. The 5-yea r probability of survival was 78% in this group, compared with 55% in women with a residual tumor more than 1 cm (log rank test, P < 0.05). Survival rates for women with tumor Grade 3 tended to be worse than Gr ades 1-2, but the difference was only of borderline statistical signif icance. No relationship emerged between survival and age, histotype, a nd presence of ascites at diagnosis. Women with a residual tumor 1 cm or less and positive lymph nodes had a 66% 5-year probability of survi val, compared with 85% for women with a residual tumor 1 cm or less an d negative lymph nodes. This difference was significant (log rank test , P = 0.05). The 5-year survival probabilities were 47 and 58%, respec tively, in women with a residual tumor more than 1 cm and positive or negative lymph nodes. CONCLUSIONS. This analysis shows a favorable lon g term survival rats for women with advanced ovarian cancer and comple te pathologic response after debulking surgery and postoperative chemo therapy. It further suggests that lymph nodal status is a prognostic f actor for women with minimal residual tumor after surgery. (C) 1996 Am erican Cancer Society.