THE EFFECT OF DIAMETER OF LARGEST RESIDUAL DISEASE ON SURVIVAL AFTER PRIMARY CYTOREDUCTIVE SURGERY IN PATIENTS WITH SUBOPTIMAL RESIDUAL EPITHELIAL OVARIAN-CARCINOMA

OBJECTIVE: The Gynecologic Oncology Group has divided patients with ad vanced epithelial ovarian cancer into those with optimal residual canc er, in which the maximum diameter of residual is less than or equal to 1 cm, and suboptimal residual cancer, in which the residual disease i s > 1 cm. Within the optimal group of patients there is a survival dif ference between patients with microscopic residual disease and those w ith any macroscopic disease less than or equal to 1 cm. No analysis of the effect of various residual disease diameters in patients with res idual disease greater than or equal to 1 cm has been performed. This s tudy evaluates the effect of residual disease diameter in patients wit h suboptimal disease entered on a randomized trial of intense versus s tandard chemotherapy. STUDY DESIGN: Gynecologic Oncology Group protoco l 97 compared cisplatin 50 mg/m(2) and cyclophosphamide 500 mg/m(2) fo r eight courses with the same drugs at 100 mg/m(2) and 1000 mg/m(2) fo r four courses, respectively. There was no difference in progression-f ree interval or survival between the two arms. Or the 458 stage III (w ith residual disease > 1 cm) and stage IV patients entered in this stu dy, 294 stage III patients comprise the current analysis. Surgical rep orting forms, operation reports, and pathology reports were reviewed t o determine initial greatest tumor diameter and residual tumor diamete r. Patients were grouped by residual diameter. Multivariate analysis c onsidered residual diameter of disease, age, histologic characteristic s, performance status, and ascites. An adjusted relative hazard of dyi ng of ovarian cancer was calculated for each residual disease group. R ESULTS: Patients ranged in age from 20 to 80 years, with a median of 6 0 years. All patients were Gynecologic Oncology Group performance stat us 0 to 2. Fifty-two percent had grade 3 tumors, and 39% and 9%, respe ctively, had grade 2 or 1 tumors. All patients had stage III disease. Ninety percent had serous, endometrioid, or mixed epithelial cell type tumors. Multivariate analysis revealed a relative risk of dying as fo llows: residual disease < 2 cm, relative risk 1.00; 2 to 2.9 cm, relat ive risk 1.90; 3 to 3.9 cm, relative risk 1.91; 4 to 5.9 cm, relative risk 1.74; 6 to 7.9 cm, relative risk 1.85; 8 to 9.9 cm, relative risk 2.16; greater than or equal to 10 cm, relative risk 1.82. The differe nce in survival between those with < 2 cm residual disease and those w ith greater than or equal to 2 cm residual disease was significant (p < 0.01). There is no significant difference in the risk of dying betwe en groups with residual disease greater than or equal to 2 cm. CONCLUS IONS: Among patients with suboptimal (> 1 cm residual disease) epithel ial ovarian cancer, those who have small diameter residual disease (< 2 cm) tend to survive longer than those who have larger residual disea se. Among those with larger residual disease, size does not affect pro gnosis appreciably.